運用羅氏適應模式於一位肝內膽管癌患者之護理經驗

Nursing Experience of a Patient with Intrahepatic Cholangiocarcinoma Using Roy's Adaptation Model

道囊腫，因術中病理切片報告被診斷為肝內膽管癌，因此造成個案身體、心理皆遭受極大的衝擊。護理期間為2016年11月02日至2016年11月20日，藉由實際照護、會談、觀察及身體評估方式收集資料，運用羅氏適應模式進行整體性評估，確立病人有急性疼痛、高危險性感染、焦慮等護理問題。護理過程中針對疼痛處理，除了適當止痛藥物外，教導放鬆技巧及轉移注意力方式來減輕傷口疼痛；採取導管組合式照護措施，預防感染情形發生；並與個案建立良好護病關係，透過傾聽、陪伴與情緒支持，並協同家屬運用芳香療法合併瑞典式按摩，來降低個案之焦慮，在情緒平穩後給予疾病相關資訊。使個案於生理功能、自我概念、角色功能及相互依賴各方面均能適應成功。礙於臨床上無瑞典式按摩課程，筆者只能於文獻中自學為主要護理限制。建議未來可於在職教育中加入瑞典式按摩方法，改善病人血循、舒緩肌肉及放鬆情緒的功效。並期望藉由本篇護理經驗分享，做為日後臨床照護之參考。（澄清醫護管理雜誌2019；15（3）：34-44） This article explores the provision of care to a case of a 41-year-old man who was diagnosed with benign biliary cysts. He was diagnosed with intrahepatic cholangiocarcinoma by intraoperative pathology, which resulted in significant physical and mental impact. The care period lasted from November 2 to 20, 2016. Data were collected through actual care, interviews, observations, and physical assessments, and Roy's adaptation model was used for overall assessment to identify acute pain, high-risk for infection, and anxiety in the patient. During care, in addition to appropriate analgesics, the patient was taught relaxation techniques to divert attention to reduce the pain from the wound. Catheter-combined care measures were adopted to prevent infection. In addition, we established a nurse-patient relationship by listening and through companionship and emotional support. In addition, we worked with family members to use aromatherapy combined with Swedish massage to alleviate anxiety in the patient and provide diseaserelated information when the patient was emotionally stable. This enabled the patient to be successful in restoring hysiological function, self-concept, role function, and interdependence. The major care limitation was the lack of a Swedish-style massage course in the clinic, and the author could only self-learn from the literature. We suggest that a Swedish massage method be added to the on-the-job education in the future to improve the patient's blood circulation, relieve muscles, and relax emotions. We hope that this nursing experience can be used as a reference for future clinical care. (Cheng Ching Medical Journal 2019; 15(3): 34-44)