照顧一位未婚女性乳癌病人接受重建手術之護理經驗

A Nursing Experience of Caring for an Unmarried Woman with Breast Cancer Undergoing Breast Reconstruction Surgery

本文描述照護一位未婚女性罹患乳癌並接受乳房重建手術之護理經驗。個案術後除面臨傷口疼痛與身體不適，亦因擔憂恢復情形、疾病與重建相關知識不足，以及顧慮男友對外觀改變的接受程度，而產生焦慮及身體心像之困擾。照護期間為2024年10月4日至10月13日，筆者運用Gordon十一項健康功能型態進行整體性評估，藉由觀察、傾聽、會談、身體評估及病歷查閱等方式蒐集資料，確立急性疼痛、焦慮及身體心像改變三項健康問題。護理過程中，依個案需求提供個別化照護，配合藥物治療、舒適擺位、按摩、音樂及放鬆技巧減輕術後疼痛；運用困擾溫度計篩檢整體情緒困擾，並透過芳香療法、音樂治療、傾聽、陪伴及澄清重建與術後照護疑問，以緩解焦慮；維護換藥隱私、引導個案逐步觀看及觸摸重建部位，並在個案同意下邀請男友參與溝通與照護，使其逐步接受重建後外觀、提升自我肯定並恢復生活步調。建議照護未婚乳癌女性時，應兼顧疼痛、情緒、身體心像與親密關係需求，並透過跨專業合作及持續追蹤，提供具隱私、個別性與連續性的整合照護。

This article describes the nursing experience of caring for an unmarried woman with breast cancer who underwent breast reconstruction surgery. Following surgery, the patient experienced wound pain and physical discomfort, anxiety about recovery, insufficient knowledge of breast cancer and reconstruction, and concerns regarding her boyfriend's acceptance of her altered appearance. Nursing care was provided from October 4 to October 13, 2024. A holistic assessment was conducted using Gordon's 11 Functional Health Patterns. Data were collected through observation, active listening, interviews, physical assessment, and medical record review. The identified health problems were acute pain, anxiety, and altered body image. Individualized interventions included pharmacological treatment, comfortable positioning, massage, music, and relaxation techniques to relieve postoperative pain. The Distress Thermometer was used to screen overall emotional distress, while aromatherapy, music therapy, active listening, therapeutic presence, and clarification of reconstruction and postoperative care were provided to alleviate anxiety. Privacy was maintained during wound care, and the patient was gradually guided to view and touch the reconstructed breast. With her consent, her boyfriend participated in communication and care, helping her accept her reconstructed appearance, enhance self-acceptance, and resume daily life. Based on this experience, it is recommended that when caring for unmarried women with breast cancer, their needs regarding pain, emotions, body image, and intimate relationships should be simultaneously addressed. Through interprofessional collaboration and continuous follow-up, an integrated care approach providing privacy, individuality, and continuity can be achieved.