應用緩和傷口照護於末期病人四級壓瘡之傷口護理經驗

The Nursing Experience of Applying Palliative Wound Care for Stage IV Pressure Ulcer in a Patient at the End of Life

曹文昱(Wen-Yi Tsao)；許美玉(Mei-Yu Hsu)

末期病人 ； 壓瘡 ； 四級 ； 緩合性傷口照護 ； end of life ； palliative wound care ； pressure ulcer ； stage IV

志為護理-慈濟護理雜誌

14卷5期（2015 / 10 / 01）

82 - 92

繁體中文

本文探討一位末期老年病人尾薦骨四級壓瘡傷口護理經驗。經整體性傷口評估發現：多量滲液、惡臭及感染的不癒合傷口，造成病人生理心理的困擾。照顧者接受到不同傷口護理訊息感到困惑；對執行傷口護理缺乏信心而感到壓力。醫護團隊運用緩和性傷口照護概念及壓瘡照護實證指引介入，依據病人及照顧者需求，提供傷口症狀控制護理措施，緩解病人生理痛苦；穩定傷口，避免壓瘡再發生。以主動接觸、陪伴、傾聽及溝通，鼓勵照顧者分享感受，且引導傷口照護決策、教導傷口照護知識與技能，緩解其壓力，進而能夠於居家執行傷口照護計劃。

The aim of this study was to describe the nursing experience of caring an elderly with a stage IV pressure ulcer at the end of life. Comprehensive wound assessment revealed that heavy exudates, malodor, and infection from the nonhealing pressure ulcer had caused the patient to suffer from physical and emotional turmoil. Caregivers were confused by complex and varying wound care information they received because of stress attributable to lack confidence in providing appropriate wound care. We applied the concept of palliative wound care and abided by evidence- based pressure ulcer guidelines in accordance with patient and caregivers needs to facilitate wound symptom control, thereby reduced physical suffering of patient and prevented pressure ulcer recurrence. As previously mentioned concept and guidelines, we provided active contact, accompaniment, listening and communication, and encouragement to motivate caregivers to share their feelings. We imparted wound-care-related knowledge and skills to the caregivers and were thus able to involve them in making well-informed wound care decisions. Our teaching had reduced their stress and helped them perform wound care at home.

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