照護一位腦腫瘤行清醒開顱手術結合長照2.0病人之經驗

Nursing Experience in Caring for a Patient with a Brain Tumor Undergoing Awake Craniotomy and Applying Long-term Care Plan 2.0

本文探討一位額葉腦腫瘤選擇行清醒開顱手術個案之照護經驗，於2020年8月31日至2020年10月20日，照護期間透過手術前後訪視、查閱病歷等方式，以身、心、社會和靈性層面，進行手術前、中、後整體性護理評估，確立個案有焦慮、言辭溝通障礙及增進復原力的準備度之健康問題。照顧過程中，配合文獻查證，主動關懷、筆談、同理心及心理支持，鼓勵表達內心感受，藉由召開跨團隊醫療合作及醫病共享決策家庭會議，讓個案與家屬可藉由此會議表達及提出心中疑慮，獲得問題澄清，並擬定出院準備計畫及長照2.0措施介入，提供個案及家屬出院後相關資源，使其盡快回復生活品質，並減輕家庭及社會負擔。此個案為本院少數手術案例，建議將清醒開顱手術之疾病照護納入在職教育，增進同仁對此疾病敏感度，為爾後照顧此類個案之臨床運用，提升清醒開顱手術個案照護之滿意度。

In this study, the nursing experience of caring for a patient with a frontal lobe tumor who had received an awake craniotomy was discussed. Between August 31, 2020, and October 20, 2020, care for the patient was administered through pre- and postoperative visits, medical record reviews, and other methods. Comprehensive assessments covering physical, psychological, social, and spiritual aspects were conducted before, during, and after the surgery. The health concerns identified for the patient were anxiety, verbal communication difficulties, and an enhanced need for resilience . During the caregiving process, the literature was referenced; proactive care, written communication, empathy, and psychological support were provided, encouraging the patient to express their thoughts. Through interdisciplinary medical collaborations and shared decision-making meetings with the patient’s family, the patient and their family expressed concerns and had their uncertainties addressed. A discharge plan incorporating Long-term Care Plan 2.0 interventions was also drafted, providing the patient and their family with relevant resources after discharge from the hospital, supporting a quick increase in quality of life and reducing the burden on both family and society. This is one of the few cases of awake craniotomy undertaken by the hospital. We recommend that future in-service nursing education include topics on the care of patients receiving this operation to raise awareness of this disease, as well as to equip nurses with the clinical skills to care for such patients, thereby enhancing the quality of nursing care at the hospital and improving patient care satisfaction.