運用藝術治療協助乳癌婦女面臨身體心像改變之護理經驗

Nursing Experience Using Art Therapy to Help Women With Breast Cancer Face Changes in Body Image

本文描述一名女性職業畫家，因罹患雙側乳癌進行雙乳切除，術後傷口疤痕及化學療法副作用導致的掉髮問題，使個案失去身體外觀自信心，甚至失去藝術創作的動力。個案因身體心像調適問題，曾流著淚哭訴自己變醜。乳房切除個案不僅藥物治療，更需要調適身體形象改變的心理狀態，以幫助減少負面情緒，故引發筆者收案動機。護理期間自2021年9月23日至12月30日，筆者藉由觀察及訪談，運用身、心、靈、家庭社會層面評估收集資料，確立個案健康問題有：身體心像改變/與手術後對身體的看法改變、化療掉髮有關、肢體活動功能障礙/與手術後上肢關節運動受限有關、噁心感/與化學治療副作用有關。鼓勵個案重拾畫筆，以藝術創作撫慰自我內心的方法、引導個案表達內心感受，以面對身體外觀改變的衝擊、提供照護諮詢管道與乳癌病友經驗分享、並協助個案調適內心衝擊，以正向態度面對抗癌療程。藝術治療的方式多元，舉凡繪畫、音樂皆納入藝術治療範疇中，亦是一項非常有價值的工具，可以幫助病人在身心上得到治癒，建議護理人員運用藝術治療時能將病人的親密家人納入治療過程，共同照護渡過難關。藉由此護理經驗，期能提供未來護理同仁實務參考。

The subject in this study was a female professional painter who underwent bilateral mastectomy because of bilateral breast cancer, experienced postoperative wound scarring, and developed alopecia due to the side effects of chemotherapy, which caused the patient to lose body image confidence and the motivation to engage in artistic creativity. The patient had shed tears early in the intervention and complained of difficulties with body image adjustment due to her altered appearance. Mastectomy patients must not only undergo drug treatment but also adjust psychologically to body image changes to decrease negative emotions. This was the author’s motivation for involvement in this case. The nursing period was from 23 September to 30 December 2021. Physical, mental, spiritual, social, and family data were collected using observations and interviews. These data were evaluated and the main problems were determined to be disturbed body image related to altered body perception post-surgery, alopecia caused by chemotherapy, impaired physical mobility due to upper limb mobility limitations post-surgery, and nausea due to chemotherapy. The patient was encouraged to paint again and to use artistic creativity to comfort herself. Moreover, she was guided to express her innermost thoughts to face the impact of her changes in appearance. In addition, a care consultation channel was provided to facilitate experience sharing with other breast cancer patients, thus assisting the patient to cope with the mental impact of her treatments and face subsequent cancer treatments with a more positive attitude. Art therapy embraces a diverse variety of methods, including drawing and music. Art therapy is a valuable tool that facilitates both physical and mental healing. Based on this experience, nurses should include patients’close relatives when performing art therapy to facilitate shared care to overcome difficulties. We hope this nursing experience provides a practical reference for nurses.