照護一位大腸癌患者術後併腸造口之護理經驗

Nursing Experience in Caring for a Postoperative Colorectal Cancer Patient with a Stoma

本文敘述一位初次診斷大腸癌男性術後併腸造口導致焦慮不安、身體心像紊亂，引發筆者深入探討動機。護理期間為2025年3月10日至3月17日，採用Gordon十一項評估架構，透過會談、觀察、身體評估蒐集資料，分析後確立個案有焦慮、急性疼痛及身體心像紊亂之護理問題。提供個別化護理指導，運用同理心關懷以建立良好的護病關係，引導個案表達其內在的不安情緒，給予適切的鼓勵與正向支持，促進對腸造口之接受程度，並依據實證護理介入音樂療法緩解個案之生理性疼痛與心理性焦慮，提升術後生活品質，最後在家人及醫療團隊的共同支持與鼓勵下，個案得以順利出院，並展現出較以往更正向的生活態度。建議面對此類病人，能於初診斷時，及早提供相關關懷團體給予心理支持，提升病人罹癌接受度，並將音樂療法納入標準照護程序，降低生理疼痛及心理焦慮程度。期盼本次護理經驗有助於提升臨床護理人員在腸造口個案照護中，提供心理支持與整合性照護的能力，進而強化護理實務的整體照護品質。

This article describes a male patient newly diagnosed with colon cancer who experienced anxiety and body image disturbance following surgery and the creation of a colostomy. The nursing care period spanned from March 10 to March 17, 2025. Using Gordon's Eleven Functional Health Patterns as the assessment framework, data were collected through interviews, observation, and physical examination. After analysis, the nursing problems identified were anxiety, acute pain, and disturbed body image. Individualized nursing guidance was provided, emphasizing empathetic care to establish a strong nurse-patient relationship. The patient was encouraged to express his inner emotional distress, and appropriate encouragement and positive support were offered to enhance his acceptance of the colostomy. Evidence-based nursing interventions, including music therapy, were applied to alleviate both physiological pain and psychological anxiety, thereby improving the patient's postoperative quality of life. With the joint support and encouragement of his family and the healthcare team, the patient was successfully discharged and demonstrated a more positive attitude toward life than before. It is recommended that for patients facing similar conditions, psychological support through relevant support groups should be offered early at the time of diagnosis to improve cancer acceptance. Furthermore, music therapy should be incorporated into standard care protocols to reduce physical pain and psychological anxiety. This nursing experience is expected to enhance clinical nurses' competencies in providing psychological support and integrated care for patients with colostomy, thereby improving the overall quality of nursing practice..