照護一位肺癌病人行肺葉切除術的護理經驗

A Nursing Experience for Caring a Lung Cancer Patient with Lobectomy

本報告係描述照顧一位因健康檢查發現胸部X光異常、胸部電腦斷層報告為左側肺部腫瘤，入院接受胸腔鏡，行左上肺葉切除手術，並於術中進行切片檢查，確定診斷為肺癌的個案之護理經驗。照護期間自2021年11月17日至11月23日，藉由觀察、會談、傾聽、病歷查閱、身體評估及直接照護收集資料，運用Gordon十一項功能性健康型態評估表，確立主要護理問題為：焦慮／與肺癌手術有關、急性疼痛／與手術傷口及引流管路有關、睡眠型態紊亂／與身體舒適改變、知覺刺激增加有關。照護期間，筆者藉由傾聽、主動關懷及同理心，鼓勵個案表達接受肺葉切除手術過程及術後壓力和肺癌預後的認知及感受，並參照近年實證護理研究融入臨床照護，給予個別性的護理，增進自我認同感，成功緩解其健康問題。由於筆者任職於外科病房，照護對象以手術前後期照護為主，其中因肺癌進行肺部手術的個案有增加的趨勢，且此個案是在健康檢查中發現罹癌，其內心所產生的衝擊與恐懼、面對治療的焦慮、術後傷口疼痛，以及擔心生活品質受到影響等問題，都是需要被重視與照護，故引發筆者欲深入探討的動機，並期望藉由此護理經驗提供臨床照護參考，以提升護理照護品質。

This case report describes a care experience of a patient who was found to have a tumor at the right lung on CT due to an abnormal chest X-ray from health examination. Diagnosis was made using an intraoperative slice. Under the diagnosis of lung cancer, he received thoracoscopic resection of the right upper lung. This report describes the nursing care of the patient from 17th to 23rd of November, 2021. Data were collected through observation, interviews, listening, medical records reviews, physical examination and direct nursing care based on Gordon 11 Functional Health Pattern Assessment. The major problems were: anxiety, which was associated with lung cancer surgery, acute pain, which was associated with surgical wounds and drainage, sleep patterns disturbance, which was associated with changes in physical comfort and increased perceptual irritation. Through listening, active care and empathy, the patient was encouraged to express his/her cognition and feelings about the process of lobectomy, the postoperative stress and prognosis of lung cancer. Evidence from recent nursing researches were also incorporated to provide personalized nursing care to improve self-recognition, and successfully alleviated his/her health problems. It is recommended to hold courses related to psychological care to improve nursing skills. It is expected that this nursing care experience provides essential clinical information as a reference for clinical professionals to improve the quality of nursing care.