一位乳癌短期內復發轉移病人之個案管理照護經驗

Case Management of Care for a Breast Cancer Patient with Recurrence and Metastases Over a Short Time Period

本文是應用個案管理於一位乳癌患者治療後，短期內又發現多處轉移需再次進行化學治療之護理經驗。護理期間自2017年12月19日至2018年2月26日，筆者以Gordon十一項功能健康型態進行評估，確認有焦慮、口腔黏膜改變、急性疼痛及預期性哀傷等問題。照顧過程中，除了依據化療副作用評估結果，提供正確口腔照護及緩解疼痛不適外，亦協助聯繫多專科團隊介入，提供持續性的照護，陪伴參加乳癌支持團體及學習正念減壓，並協助調適預期性哀傷的歷程，使其能以正向的態度面對復發所帶來的衝擊與壓力，達到身心靈安定的狀態。

This article describes the nursing experience of a case manager caring for a breast cancer patient who was found to have multiple metastases over a short period of time. The nursing period was from December 19, 2017 to February 26, 2018. Applying Gordon’s 11 functional health patterns for a comprehensive nursing assessment, the case manager found the patient to have the following health problems: anxiety, oral mucosal changes, acute pain and anticipatory grief. In the process of caring for the patient, the care manager relayed the results of the evaluation of side effects of chemotherapy, administered correct oral care and pain medication, contacted multiple specialist teams to provide continuous care, led the patient to attend breast cancer support groups and mindfulness based stress reduction, as well cope with anticipatory sorrow. With case controlled this way, the patient was able to face the impact and pressure brought by recurrence with a positive attitude and achieve some degree of stability of body and mind.