一位口腔癌末期病患之護理經驗

Nursing Experiences of an Oral Cancer Patient at the Terminal Stage

10.6880/TJON.200806_8(1).05

林美瑩(Mei-Ying Lin)；柯薰貴(Hsun-Kuei Ko)

口腔癌 ； 末期照護 ； 護理經驗 ； oral cancer ； terminal care ； nursing experience

腫瘤護理雜誌

8卷1期（2008 / 06 / 01）

51 - 64

繁體中文

本篇是探討一位口腔癌病患，於癌症末期面對疾病復發無法治癒的過程，經由筆者給予個案及家屬支持與鼓勵，建立信任感，協助個案接受疾病變化，正視自己的需求，最後轉介至安寧病房之護理過程。在此護理過程中經由直接照顧、觀察、會談等方式收集資料，並以陪伴和關懷建立良好的護病關係，歸納個案之主要健康問題為：疼痛、呼吸道清除功能失效、組織完整性受損、身體心像紊亂與無望感。針對個案健康問題提出個別性、整體性之護理計畫，包括協助個案減輕因腫瘤壓迫帶來的疼痛感；提供胸腔物理與其輔助療法，處理因喉部腫脹致使痰液黏稠不易排出的問題；給予個別性傷口護理使能有效改善蕈狀潰瘍性傷口的惡臭，進而使個案願意主動參與傷口照護並與家人有良性互動，以改善身體心像紊亂的問題；互動過程中以傾聽、微笑、陪伴、關懷的護理美學與專業態度照顧個案及家屬，而以正向態度面對生命最後一程；最後照會安寧共同照護，協助個案及家屬瞭解安寧理念後，轉入安寧病房接受癌末持續性照護，在生命最後階段提升其生活品質，為年輕的生命劃上無遺憾的句點。希望此護理照顧經驗能與護理同仁分享，並進而提供未來照顧類似病患之參考。

This article addressed the nursing care experiences of an oral cancer patient who faced the relapse of the disease and could not recover. During the nursing care process, the authors offered support and encouragement, established trust relationship with the patient and family, and helped the patient accept the disease. A good patient-nurse relationship was built through caring and being with the patient. The patient problems were identified as the following: (1) pain; (2) ineffective clearance of airway; (3) tissue integrity impaired; (4) disturbed body image; (5) hopelessness. The individual and holistic nursing care plans were proposed based on the patient's problems. Nursing care interventions offered included pain relief, physical therapy, and alternative therapies. We managed the problems of ineffective airway clearance due to the swelling of the larynx. Individualized wound care was provided for the patients to improve the noxious odor of the malignant fungated ulcerating wound. Through the nursing care the patient could actively participate in wound care, have better interaction with his family, and improve the disturbance of body image. During the process, we provided professional nursing care through listening, smiling, accompanying, and caring. Finally the patient could positively face the last course of his life. We combined the hospice care and assisted the patient and family to understand the meaning of hospice care. The patient was transferred to the hospice care unit and received continual care to promote his life quality at the terminal stage. At last, the young patient's life was ended peacefully without any regret. We expected to share these nursing care experiences with other nurse colleagues. Future care for the patients with the similar problems can make a reference to the nursing care experiences in this article.

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1. (2024)。照顧一位有自殺意念口腔癌復發個案之居家護理經驗。彰化護理，31(3)，129-139。