一位外籍人士罹患舌癌術後身體心像改變之護理經驗

Nursing Experience of a Foreigner With Tongue Cancer: Changes in Body Image After Surgery

本文是敘述一位外籍人士診斷舌癌後面臨手術所造成顏面外觀、說話功能及身體心像改變等身心衝擊的護理經驗，個案是一位不善於中文的外籍人士，除需面對疾病的焦慮之外，對許多不確定因素感到惶恐及不安，照護期間以傾聽、主動關懷來接納個案心中感受並建立良好護病關係。護理期間為2011年3月1日至3月26日，以Gordon十一項功能性評估工具，收集主客觀資料，確立護理問題有：（一）身體心像改變／與顏面外觀、說話功能改變有關；（二）焦慮／擔心手術風險及疾病預後有關；（三）營養少於身體所需／與進食困難導致MUST 4分有關。在照護過程中使用個別性護理措施，製作淺顯易懂的中英文翻譯圖示溝通本做為溝通橋樑，運用家庭支持系統提供情緒支持，協助個案排除語言上的隔閡，早期面對疾病預後與返家的居家照護，能接受自己身體心像的改變，達到身心適應狀態。現今醫療已無國界，台灣醫療品質的提升，已吸引許多外籍人士來台就醫，建議可增設國際醫療病房提供照護，維持最佳的護理品質。藉此護理經驗之分享，冀能提供日後護理同仁照顧此類個案之參考。

This article details the nursing experience of a foreigner who was diagnosed with tongue cancer. The patient subsequently agreed to undergo surgery, which altered his facial appearance, speech functions, and body image. Such a case is not good for Chinese expatriates, and was exacerbated by anxiety disorders, fear, and uncertainty. Nursing care was provided from March 1 to March 26 of 2011, and date were collected by listening, providing active care, and conducting an assessment by using Gordon's functional health patterns. The patient was diagnosed as having an imbalanced nutrition (the patient was consuming food that was providing less than the physical requirements), anxiety, and a disturbed body image. During nursing care, we provided appropriate nursing interventions and English translations of the communication icons used for individualized nursing care. A family support system was implemented for providing emotional support to overcome the language barrier. An early prognosis indicated that the patient can return home to receive home care, to begin and accept changes to his body image, and to adapt to his current physical and mental state. This nursing experience was presented to serve as a reference for medical professionals who might encounter similar circumstances.