運用品質關懷模式照顧一位剖腹胰尾併脾臟切除個案之手術全期護理經驗

Applying the Quality Caring Model in A Perioperative Nursing Experience of A Patient Undergoing Exploratory Laparotomy with Resection of Pancreatic Tail Tumor and Spleen

胰臟神經內分泌腫瘤發生在胰臟，手術切除為主要治療方式。本文探討一位胰臟神經內分泌腫瘤進行剖腹胰尾併脾臟切除個案之手術全期護理經驗，照護期間自2021年11月18日至11月28日，筆者以觀察、會談及病歴查閱等方式收集資料，並運用手術全期護理模式進行整體性評估，確認個案之健康問題有：急性疼痛、焦慮及潛在危險性手術情境傷害。照顧過程運用Duffy品質關懷模式，於術前訪視提供剖腹胰尾併脾臟切除手術相關資訊，緩解個案焦慮；術中透過安全維護及預防異物殘留體內，避免個案手術情境傷害；並術後依醫囑給予止痛藥、教導避免傷口牽扯及使用束腹帶等，緩解個案傷口疼痛。期望此護理經驗，能提供日後手術室護理人員照顧類似個案參考。

Pancreatic neuroendocrine tumors occur in the pancreas, and surgical resection is the main treatment. The purpose of this article was to explore a perioperative nursing experience of a patient undergoing exploratory laparotomy with resection of pancreatic tail tumor and spleen. From Nov. 18 to 28, 2021, data were collected through observation, interview, and chart review according to a comprehensive assessment with perioperative nursing model as guideline. The health problems identified included acute pain, anxiety, and risk for perioperative-positioning injury. Applying Duffy’s Quality-Caring Model, quality care elements were integrated into the caregiving process. By providing preoperative visiting and giving information about laparotomy resection of the pancreatic tail tumor and spleen, the author relieved the patient’s anxiety. Through safety maintenance, and preventing inadvertent retention of foreign material, the author avoided the perioperative-positioning injury of the patient. By giving analgesics, teaching to avoid wound involvement and using abdominal bandage, the author relieved the patient’s pain. Hopefully, this perioperative nursing experience can serve as a reference for health care professionals when caring for such patients.