104 Family Nursing of Lung Cancer Patient 照護一位肺癌腦轉移個案藉由家庭復原力模式協助其 家庭因應之護理經驗 1 2 3 4 * 1 2 3 4 摘要 : 2012 7 26 2012 8 7 關鍵詞 : 前 言 Hsiung et al., 1998 文獻查證一 肺腺癌腦轉移病人之照護 2005 Shin, Lin, Weng, & Jan, 2011 2007 103 5 6 doi:10.6224/jn.61.6.104 * 10002 7 02 23123456 66082 E-mail mihorng@ntuh.gov.tw 引用格式 2014 61 6 104 109 [Tsai, C. Y., Chen, S. C., Jhang, S. Y., & Hong, M. Y. (2014). Nursing care for a lung cancer patient with brain metastasis using the family resiliency model. The Journal of Nursing, 61(6), 104 109.] doi:10.6224/ JN.61.6.104 The Journal of Nursing Vol. 61, No. 6, December 2014
105 2000 2009 二 主要照顧者的負荷壓力及角色功能 2009 2010 2011 2004 三 運用家庭復原力模式調適 resiliency model of family stress, adjustment and adaptation 1949 Hill1993 McCubbin McCubbin Friedman, Bowden, & Jones, 2002 ㈠ ㈡ ㈢ ㈣ ㈤ 2004 個案介紹 60 2007 6 2010 1 2012 2 7 19 25 2012 7 26 2012 8 7 14 歲 13 歲 38 歲 36 歲 33 歲 32 歲 5 歲 66 歲 3 歲 1 歲 60 歲 圖一家族樹 護理過程 5 歲 一 生理層面模式 43 護理雜誌 61 卷 6 期 中華民國 103 年 12 月
106 Family Nursing of Lung Cancer Patient 30 2012 7 25 Glasgow Coma Scale GCS E3V1M5 pupil size 3,3 light reflex +/+ 26 28 GCS E4V5M6 30 8 1 二 心理層面模式 8 2 三 社會 靈性層面模式 四 家庭復原力模式㈠ 1. 2. 7 26 7 28 24 3. 4. 7 28 5. ㈡ ㈢ ㈣ The Journal of Nursing Vol. 61, No. 6, December 2014
107 7 28 護理 ㈤ 護理計畫 問題一 : 潛在危險性肺吸入 / 2012.7.26 2012.8.7 護理目標 護理措施 1-1 1-2 1-3 1-4 2-1 護理評值 7 29 8 1 問題二 : 自我照顧能力缺失 / 2012.7.26 2012.8.4 護理目標 8 4 護理措施 護理評值 8 1 4 40 8 3 問題三 : 調適障礙 / 2012.8.2 2012.8.7 護理目標 護理措施 1-1 1-2 1-3 2-1 2-2 2-3 2-4 護理評值 8 3 8 3 8 4 問題四 : 照顧者角色緊張 / 2012.7.26 2012.8.4 護理目標 護理措施 1-1 1-2 2-1 2-2 2-3 2-4 護理評值 8 1 8 4 護理雜誌 61 卷 6 期 中華民國 103 年 12 月
108 Family Nursing of Lung Cancer Patient 2 問題五 : 家庭因應能力失調 / 2012.7.28 2012.8.1 護理目標 7 31 8 1 護理措施 1-1 1-2 1-3 1-4 2-1 2-2 2-3 護理評值 7 31 8 1 討論與結論 2000 參考文獻 2005 1008-1018 [Li, H. H., Lin, L. C., Huang, Y. C., Wu, B. Y., Lin, G. M., Lin, J. C.,... Luo, S. F. (2005). Care of diseases of the respiratory system. In Y. J. Hu (Ed.), Medical-surgical nursing (1st ed., pp. 1008-1018). Taipei City, Taiwan, ROC: Farseeing.] 2000 5 3 28 31 [Chiou, S. J. (2000). Symptoms of brain metastasis and principles of management. Taiwan Journal of Hospice Palliative Care, 5(3), 28 31.] 2009 5 3 163 172 [Hong, S. H., Chang, C. S., Lin, S. Y., & Hsieh, H. F. (2009). Factors associated with caregiver burden in families of terminal cancer patients. Journal of Nursing and Healthcare Research, 5(3), 163 172.] doi:10.6225/jnhr.5.3.163 2007 12 4 443 449 [Weng, Y. C. (2007). Combination of palliative radiothrapy and palliative hospice care for brain metastases. Taiwan Journal of Hospice Palliative Care, 12(4), 443 449.] 2009 34 2 125 135 [Chang, Y. C., Huang, S. J., & Tsauo, J. Y. (2009). Effects of physical therapy in palliative care for cancer patients. Formosan Journal of Physical Therapy, 34(2), 125 135.] 2004 1 1 45 54 [Tsau, M. Y., & Chen, H. M. (2004). A nursing care experience with a patient with colorectal cancer. Journal of National Taipei College of Nursing, 1(1), 45 54.] 2010 The Journal of Nursing Vol. 61, No. 6, December 2014
109 57 2 81 86 [Chen, C. F. (2010). Experience helping a caregiver reduce stressors. The Journal of Nursing, 57(2, Suppl), 81 86.] doi:10.6224/ JN.57.2S.81 2004 51 4 107 112 [Chen, W. C., & Wang, W. L. (2004). The application of the resiliency model to caring for the family of a head injury client. The Journal of Nursing, 51(4), 107 112.] doi:10.6224/jn.51.4.107 2011 7 2 127 139 [Hsiao, C. L., & Chiou, C. J. (2011). Primary caregivers of home nursing care recipients: Their caregiving experiences and related factors. The Journal of Nursing and Healthcare Research, 7(2), 127 139.] doi:10.6225/jnhr.7.2.127 Friedman, M. M., Bowden, V. R., & Jones, E. G. (2002). Family nursing: Research, theory, & practice (5th ed., pp. 463 510). Upper Saddle River, NJ: Prentice Hall. Hsiung, C. Y., Leung, S. W., Lo, S. K., Wang, C. J., Chen, H. C., Sun, L. M., & Fang, F. M. (1998). Palliative radiotherapy for synchronous brain metastases from lung cancer. Therapeutic Radiology and Oncology, 5(1), 27 36. McCubbin, M. A., & McCubbin, H. I. (1993). Families coping with illness: The resiliency model of family stress, adjustment and adaptation. In C. B. Danielson, B. Hamel-Bissell, & P. Winstead-Fry (Eds.), Families, health, and illness: Perspectives on coping and intervention (pp. 21-63). St. Louis, MO: Harcourt Health Services. Shin, Y. T., Lin, J. C., Weng, Y. C., & Jan, J. S. (2011). Prognostic factors analysis of lung cancer patients with brain metastasis after whole brain irradiation. Therapeutic Radiology and Oncology, 18(4), 265 273. Nursing Care for a Lung Cancer Patient With Brain Metastasis Using the Family Resiliency Model Chia-Yu Tsai 1 Shu-Chuan Chen 2 Sin-Yuan Jhang 3 Ming-Ying Hong 4 * 1 BSN, RN, Oncology Ward, National Taiwan University Hospital; 2 MSN, RN, Oncology Case Manager, Department of Nursing, National Taiwan University Hospital; 3 MSN, RN, Head Nurse, Oncology Ward, National Taiwan University Hospital; 4 MSN, RN, Nursing Supervisor, Department of Nursing, National Taiwan University Hospital. ABSTRACT: This article describes the experience of the author in providing nursing care to a lung cancer patient with brain metastasis who was unable to care for herself. The period of care ran from July 26th to August 7th, 2012. The focus of the article is on the problems of disease adaptation and the coping strategies of the patient and her primary caregivers. The author used the Family Resiliency Model to collect information via physical examination, observation, and interviews. Five major nursing problems were identified in this case: risk of aspiration, self-care deficits, adjustment disorder, caregiver role strain, and family coping ineffectiveness. Based on these problems, the author constructed an individualized care plan to: 1) improve the self-care ability of the patient, 2) enhance the skills of the primary caregiver, 3) recruit the timely assistance of other family members, 4) and reduce the burden of the primary caregiver. The primary goal of this care plan was to promote the quality of life of the patient and her family. Key Words: lung cancer, brain metastasis, caregivers, family resiliency model. Accepted for publication: May 6, 2014 *Address correspondence to: Ming-Ying Hong, No. 7, Chung Shan S. Rd., Taipei City 10002, Taiwan, ROC. Tel: +886 (2) 2312-3456 ext. 66082; E-mail: mihorng@ntuh.gov.tw 護理雜誌 61 卷 6 期 中華民國 103 年 12 月