照護陰莖全切手術後病人之親密關係維持

Maintaining Intimate Relationships After Total Penectomy: A Nursing Care Perspective

「性」及「親密關係」在東方社會屬於敏感話題，在疾病治療過程常被忽略，導致術後易引發多重身心靈困擾。本文探討一位42歲陰莖癌病人接受陰莖全切及尿道重建手術所產生的身心衝擊。照護期間自2023年5月24日至6月15日，透過觀察、會談及病歷回溯等方式收集資料。個案出現手術傷口感染，亦呈現壓抑情感與首次面對罹癌的心理衝擊及陰莖切除造成的身體心像改變，對於親密關係存有疑慮及逃避，綜合評估有現存性感染、身體心像紊亂、親密關係維持困難等健康問題。照護期間運用EX-PLISSIT（extended permission limited-information specific- suggestion intensive-therapy）模型，透過了解、溝通與回饋給予親密關係相關的資訊及具體建議事項，結合跨團隊共同擬定適當醫療計畫及心理照護。藉由正向自我價值的肯定及觀察術後身體改變，協助適應外觀改變，增進自我照護能力。藉由早期護理措施介入及專業支持，引導與伴侶尋找術後親密互動方式，以維持親密感及提升生活滿意度，期盼此照護經驗可提供護理人員對陰莖癌術後病人親密關係維持的實務參考。

In Eastern cultures, sexuality and intimate relations are typically regarded as delicate issues and generally ignored in treatment processes, which may cause physical, psychological, and even spiritual suffering throughout the process of recovery. This article discusses a case report involving a 42-year-old male patient, who was diagnosed with penile cancer and subsequently received a total penectomy and urethral reconstruction. Nursing care was provided from May 24 to June 15, 2023. The information was gathered using observation, interviews, and chart reviews. In addition to a surgical wound infection, the patient evidenced emotional suppression and psychological distress associated with their cancer diagnosis and changes in body image after the penectomy. The patient displayed doubtfulness and a disposition to shun closeness. The health problems detected included infection, body image problems, and an inability to have intimacy. The model used during the care period was EX-PLISSIT (extended permission limited-information specific- suggestion intensive-therapy), which was utilized to offer education, communication and feedback concerning intimacy and potential recommendations. A multidisciplinary team worked together to develop a suitable medical and psychological care plan. By affirming the patient’s self-worth and helping them recognize and adapt to bodily changes, nursing care enhanced self-care ability. Through early nursing intervention and professional support, the patient and family were guided to explore ways of intimate interaction after surgery, helping to maintain closeness and improve life satisfaction. This experience may serve as a reference for nurses caring for patients with penile cancer to help these patients maintain intimate relationships postoperatively.