一位乳癌併發惡性蕈狀傷口病人之照護經驗

Nursing experience for a Breast Cancer Patient with Complication of Malignant Fungating Wounds

10.6880/TJON.202006_20(1).05

標芸菱(Yun-Ling Biao)；王姮樺(Heng-Hua Wang)；陳繪竹(Hui-Zhu Chen)；李文馨(Wen-Hsin Lee)

乳癌 ； 惡性蕈狀傷口 ； 共享決策 ； breast cancer ； malignant fungating wound ； shared decision-making

腫瘤護理雜誌

20卷1期（2020 / 06 / 01）

63 - 75

繁體中文

本文為一位53歲女性因延遲就醫，造成局部晚期乳癌併發蕈狀傷口的護理經驗，護理期間自2018年1月15日至1月21日，藉由會談、觀察及傾聽等方式，依生理、心理、社會及靈性做資料歸納與收集，確立個案有組織完整性受損、抉擇衝突及焦慮等健康問題。於照護過程中，運用「TIME」概念評估蕈狀傷口導入照護策略，教導並示範自我傷口照顧方式，以有效控制傷口出血、潰爛等症狀；個案因過往案姐化療副作用不良經驗，加深對化學治療的恐懼而陷入抉擇困境裡，藉由與個案建立良好的信任感，提供情緒宣洩管道，透過病友的鼓勵增強治療的自信心，經醫療團隊共同邀請個案及家人參與治療計劃選項，運用共享決策步驟協助個案選定前導性輔助性標靶化學治療為最合適治療方式，能夠以正向態度持續接受治療，提升個案的生活品質。目前國內將醫病共享概念導入癌症治療決策尚在起步階段，癌症病人在面對治療後不確定風險時，容易導致醫療糾紛發生，故建議臨床教育可多加推廣此概念，落實以病人為中心之照護理念，未來讓更多乳癌手術病人能夠受惠。

This paper presents the nursing experience for a 53-year-old female patient who had locally advanced breast cancer complication of malignant fungating wounds associated with delayed medical treatment. The duration of nursing care for the patient was January 15 to 21, 2018. Through interview, observation, and listening, collection and compilation of the related information were carried out according to the physical, psychological, social and spiritual aspects of the patient. Then the paper determined the health concerns of this patient, including impaired skin integrity, decisional conflict and anxiety. In the nursing process, the concept of ＂TIME＂ was employed to evaluate the nursing strategy for the malignant fungating wounds. The researcher taught and demonstrated self-care of the wound in order to effectively control the bleeding and ulcerating symptoms of the wound. However, the patient faced a decision-making dilemma after having a bad experience with side effects from a past chemotherapy, which deepened her fear of chemotherapy. Through establishment of a good sense of trust with the patient, provision of a channel for emotional catharsis, and strengthening of self-confidence in therapy after encouragements from other patients having the same symptoms, the medical team invited the patient and her family to participate in selecting the therapy plans. With the use of shared decision-making procedures, the patient was assisted in selecting neoadjuvant target chemotherapy as the most suitable treatment method. As a result, the patient had a positive attitude towards continuing the therapy and her quality of life was thus improved. Currently, incorporating the concept of shared decision-making into patient treatment decision process is still at its initial stage. When a cancer patient faces the risk of uncertainty from therapy, it is likely for the medical dispute to arise. Therefore, this paper suggests that this concept should be further promoted in the clinical education to materialize the patient-centered caring concept so that more breast cancer patients receiving therapy could be benefited in the future.

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