照護一位產後婦女面對初診斷乳癌及乳房重建手術之經驗

Nursing Experience of a Postpartum Woman with Newly Diagnosed Breast Cancer and Breast Reconstruction

本文描述一位初診斷乳癌之產後婦女接受乳房切除及重建手術之照護經驗，護理期間為2019年08月21日至2019年08月27日，以Gordon十一項健康功能型態為評估工具，藉由觀察、會談、身體評估及病歷查閱等方式收集資料，發現病人有「焦慮」、「術後照護知識缺失」與「身體心像改變」之健康問題；在術前因對手術過程不清楚與術後外觀的改變而產生焦慮，護理過程中運用多團隊共同照護模式、焦慮量表進行客觀評估，並照會腫瘤心理師提供協助，以幫助病人重新調整心態，勇於面對身體心像改變帶來的心理衝擊；在術後適時幫助病人緩解傷口疼痛之問題，鼓勵病人與案夫共同參與傷口照護，引導正向面對病人重建後的乳房與肢體的復健運動，把重建後的乳房視為身體的一部分，並參與討論返家照顧需求與可利用社會資源，進而擁有更好的生活品質。建議護理人員平時可利用單位種子教師進行跨科別領域的護理照護訓練，在面對同時有成人與婦幼健康問題的病患，才能適時提供正確資訊，另外也可定期邀請乳癌個管師或主治醫師至病房進行個案照護的在職教育，透過團隊討論以提升照護品質。

This article describes the nursing experience of a postpartum woman with newly diagnosed breast cancer. The patient underwent a mastectomy and breast reconstruction. The period of care spanned from August, 21, 2019 to August, 27, 2019. The patient had several health problems including anxiety, inadequate knowledge regarding post-operative care, and changes in body and mental image. The patient’s anxiety was mainly caused by not understanding the surgery and the change in body image. In the caring course, the care model of multi-team joints used the anxiety scale for objective evaluation. The oncology psychologist also assisted the patient in readjusting her emotions, and encouraged the patient to face the psychological impact caused by the bodily and mental changes. During treatment, we provided the patient with pain control in the early postoperative period. During the process of pain control we encouraged the patient and her husband to participate in wound care. Additionally, we advocated positive mindsets to encounter reconstructed breasts and rehabilitation exercise for limbs. The patient participated in the discussion of the need for home care and the use of social resources to have a better quality of life. This study suggested that nursing staffs can leverage the unit seed teachers to conduct cross-disciplinary nursing training and provide timely and accurate information to patients with both adult maternal and child health problems. In addition, they can also regularly invite breast cancer managers or attending surgeons. They can provide an educational perspective on patient care through team discussions to improve the quality of care.