運用Orem理論於一位直腸癌患者之手術全期護理

Applying Orem's Theory to Perioperative Nursing for a Patient with Rectal Cancer

本文為照護一位直腸癌患者接受低前位切除手術之全期護理經驗，護理期間為2007年12月17日至2008年1月28日。在手術前、中、後期藉由觀察、訪談、傾聽並應用Or em理論及手術全期護理理論等技巧收集資料、確立問題。在過程中發現問題包括有：手術前：焦慮；手術中：潛在危險性傷害、高危險性體溫過低；手術後：知識缺失。在整個照護過程中應用Or em理論在術前提供病患支持與教育性的護理措施，增加個案對手術的認知，減輕焦慮不安的情緒，使其能安心的面對手術；術中個案因麻醉完全失去自我照顧能力此時給予完全代償性護理措施，以預防因使用電燒器與截石臥位而造成的潛在危險性傷害並提供保暖相關措施以避免體溫過低情形發生；術後至自我照顧能力恢復期間，提供部分代償性護理；恢復後期至出院做準備時，提供支持與教育性護理，以促進手術後自我照顧能力。希望藉由此次經驗能提供手術室護理人員照護此類病患之參考。

This report describes the perioperative nursing experience with a patient with rectal cancer who received a lower anterior resection. Based on the concept of perioperative nursing care and the guidelines from Orem’s theory of self-care, we provided tender care, close observation, physical evaluation, pre-operative and postoperative visits, and intra-operative nursing care for this patient during his hospitalization from 17 December 2007 to 16 January 2008. We used Orem’s self-care patterns as a theoretical basis for assessing the patient's physical, mental, and social health needs. Preoperatively, the patient's most important health problem was anxiety, intraoperatively, the potential risks for injury and hypothermia, and postoperatively, a deficiency of knowledge. During the preoperative period, nursing care involved empathetic listening and teaching the patient how to dress a wound to help him effectively face the challenges of surgery.