根除性攝護腺切除手術護理指導改善方案

Improvement Project for Nursing Instructions Provided to Radical Prostatectomy Surgery Patients

本文旨在敘述一位經低前位直腸癌切除及保護性腸造口手術後個案，因結腸造口存在的心理衝擊，排斥學習，造成自我照護障礙之護理經驗。於2012年8月23～9月6日護理期間，藉由觀察、傾聽及溝通，並輔以Gordon11項功能性健康型態評估方法，發現個案拒絕接受相關護理衛教，有焦慮、身體心像紊亂、知識缺失等健康問題。運用「關懷照護」的概念，於護理期間導入治療性溝通，建立良好的護病關係，使個案能敞開心胸，正向面對自我，並與家屬學習自我照顧，提升生活品質，翼望藉此次護理經驗的分享，作為以後照顧此類個案之參考。

This case report describes a nursing experience in caring for a patient receiving low anterior resection and colostomy who experienced psychological effects generated by his rectal cancer. The duration of nursing care was from August 23, 2012 to September 6, 2012. The Gordon function health assessment guide was used to assess nursing problems. Based on clinical data collected from observations, listening, and communication, the patient experienced health problems such as anxiety, disturbance by body image, and knowledge deficit. The patient's perception of his disease changed positively after several therapeutic conversations that entailed using a therapeutic communication technique of nursing care. As the nurse-patient relationship became firmly established, the patient was gradually able to confront his disease in positively and accept standard colostomy care, and could return to a life less interrupted by his disease. This nursing experience can provide several implications for comprehensive nursing care that can be applied in similar cases.