運用賦權概念於口腔癌病人合併惡性蕈狀傷口之照護經驗

Nursing Care through Empowerment for an Oral Cancer Patient with Malignant Fungating Wounds

10.6880/TJON.201911/SP_19.05

蔡佩真(Pei-Chen Tsai)；林怡芳(Yi-Fung Lin)

口腔癌 ； 惡性蕈狀傷口 ； 腫瘤傷口換藥 ； 賦權概念 ； malignant fungating wounds ； tumor wound dressing ； empowerment

腫瘤護理雜誌

19卷增訂刊II（2019 / 11 / 01）

57 - 68

繁體中文

口腔癌對於病人不僅造成死亡威脅，伴隨疾病進展及傷口惡化所帶來的生活衝擊及改變，這些對於病人及家屬皆是心力交瘁的主要原因。本文藉由照護一位口腔癌病人伴隨著惡性蕈狀傷口的護理經驗，於2017年4月11日至2017年5月19日期間，透過Gordon十一項健康功能型態評估，歸納出個案正面臨的健康問題有：皮膚完整性受損、疼痛以及家庭因應能力失調等健康問題。筆者運用賦權照護模式於臨床應用之五步驟，評估病人的處理能力及有效資源等，並藉由多科照會系統達成醫療團隊共同合作；同時，鼓勵病人與家屬學習相關照護技能，進而察覺自身問題、提升自我解決能力，建立雙向之「護病夥伴關係」，透過提早準備出院事宜，最後成功讓病人及家屬能順利出院並有能力自我居家照護。建議需長期居家照護之病人能夠及早接受居家照護技巧指導，以提升病人與照顧者信心，早日回歸家庭生活，促使病人與家屬創造「與癌症共存」的生活目標，達到良好的疾病自我管理。

People who are diagnosed with oral cancer inevitably undergo life threatening situations with numerous lifestyle changes and challenges. Needless to say, the consequences of oral cancer are the predominating causes of caregiver's and patient's frustrations. This article illustrates the experience of nursing an oral cancer patient with a malignant tumor wound. Through Gordon's eleven functional health steps, in the period of April 11, 2017 to May 19, 2017, three major nursing issues were revealed; 1) impaired skin integrity, 2) wound pain, and 3) ineffective coping and adaption. The five steps of empowerment theory were introduced to assess the patient's ability of coping in association with the section of available clinical resources. Collaborating and engaging with a multidisciplinary team, as well as encouraging the patient and his family to learn associated nursing techniques were imperative to facilitate the patient's and his family's self-awareness, problem solving skills and partnership of the patient and nurses. In this case study, the patient was discharged home with established skills and abilities to care for himself at home. Overall, the complexity of caring for cancer patients with malignant fungating wounds calls for guidance from a holistic interdisciplinary team. Patients who need long term home nursing care should receive early guided education at an early stage so as to promote confidence and competence in the patient and family to co-exist with and manage the illness.

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