照顧一位直腸癌術後併暫時性腸造口個案之護理經驗

Nursing Experience of Caring for a Rectal Cancer Patient with Temporary Colostomy

本文描述一位直腸癌婦女術後併暫時性腸造口之照護經驗，筆者於2018年11月20日至11月29日照護期間，運用Gordon十一項健康功能為評估工具，藉由身體評估、會談及觀察的方式收集資料，分析後發現個案有急性疼痛、腸造口照護知識缺乏及身體心像紊亂之護理問題。運用家庭支持及醫療團隊合作，使用藥物及非藥物的治療方式，讓個案減輕疼痛不適；利用衛教單張及實際操作教導個案及家屬返家後造口的照護及注意事項，鼓勵個案及家屬表達其擔憂，藉著成功適應之病友分享，協助個案勇於面對身體心像所帶來的衝擊。於個案出院後，多次電話訪問，追蹤返家後續照顧情況，個案已可自我照護腸造口及社交活動。建議面對此類病患可於手術前給予充分資訊，並介紹病友分享自我照護經驗，以減輕個案對造口術的擔心，提升其學習照護的意願，早日適應新生活。期盼藉著分享照護經驗，讓臨床照顧類似病患的護理人員有所參考。

This article describes the care experience of temporary colostomy in a woman with rectal cancer. The first author taking care of the patient from November 20th to 29th, 2018. By means of physical assessment, interviews, observation techniques and Gordon 11 function health pattern to collect data. Consequently, three nursing problems were identified: acute pain, knowledge deficit (colostomy care), and disturbed body image. In order to diminish the patient's signs and symptoms, the medical team worked with the patient's families, used pharmaceutical and non-pharmaceutical methods to care this patient. Also, the nurse taught the patient and his families how to care colostomy and provided information leaflet to enhance their capabilities of care. To face the impact of disturbed body image, the nurse encouraged the patient and her families to express their concerns and introduced well adapted patients to share their experiences. After the patient discharged, the nurse gave follow up calls to check the patient's condition. Consequently, the patient took care herself well and had taken part local social activities. It was suggested that sufficient colostomy care information should be given to the patients before surgery. Introducing well adapted patient to share their experiences can decrease the patient's anxiety and increase the patient's intention to learn the caring techniques. Hope this experience can as a reference for those nurses who taking care the similar patients.