協助一位口腔癌復發病人面對出血性蕈狀傷口之護理經驗

Nursing Experiences of Caring for a Oral Cancer Patient with Bleeding from Malignant Fungating Wounds

10.6880/TJON.202306_23(1).08

賴淑婷(Shu-Ting Lai)；謝書華(Shu-Hua Shie)

蕈狀傷口 ； 慢性疼痛 ； 無望感 ； fungal wound ； chronic pain ； hopelessness

腫瘤護理雜誌

23卷1期（2023 / 06 / 01）

93 - 102

繁體中文;英文

本文探討一位55歲口腔癌病人面對13年後疾病復發合併出血性蕈狀傷口，引發身心困擾之護理過程。筆者於2019年7月18日至2019年8月25日照護期間，藉由實際參與照顧，運用會談、觀察、身體評估及肢體語言等方式蒐集個案資料，依生理、心理、社會及發展、靈性的四大層面，以全人的方式來分析，確立個案的主要健康問題有「組織完整性受損」、「慢性疼痛」及「無望感」。照護過程中筆者依據個案蕈狀傷口出血與惡臭等傷口特性，設計出個別化的換藥方式，鼓勵個案及家屬參與照護過程，運用換藥錄影教學及易記口訣，進而增加傷口護理技能；針對個案提供有效的止痛藥物及非藥物治療，如：播放舒緩音樂及精油經絡按摩使用，以緩解疼痛帶來的不適；對於個案因疾病復發失去控制所延伸之無望感，藉由鼓勵個案表達負面情緒感受及身心俱疲的壓力，讓其感受到生命備受重視，進而願意走出限制瞭解自我，學習面對哀傷、接受自己，使個案重新肯定自己存在的價值與意義。經由此次照護經驗，筆者深深感受到癌症病人於多年後疾病復發引起的種種不適及重新面臨死亡的恐懼及壓力，對其及家庭皆會造成極大影響，期望此案例的成功經驗分享，提供臨床護理人員照顧類似病人時參考，真正落實全人照護。

This article discusses the nursing care for a 55-year-old oral cancer patient who experienced disease recurrence and a bleeding fungal wound 13 years later, causing physical and psychological distress. During the care period from July 18, 2019 to August 25, 2019, the author collected patient data through participation in caregiving, utilizing methods such as interviews, observation, physical assessment, and non-verbal communication. Through a four-dimensional analysis of physiology, psychology, social development, plus that of spirituality, the author identified the main health issues as "compromised tissue integrity," "chronic pain," and "sense of hopelessness." Throughout the nursing care process, the author tailored wound dressing methods based on the characteristics of the fungal wound, including bleeding and odor. The author also interacted with the patient and the family in the caregiving process, where the author provided instructional videos on wound dressing and memorable phrases to enhance wound care skills. Effective pain management strategies, both pharmacological and non-pharmacological, such as playing soothing music and using aromatherapy for meridian massage, were provided. Addressing the extended sense of hopelessness resulted from the disease recurrence and loss of control, the author encouraged the patient to express negative emotions and the overwhelming stress of physical and mental exhaustion. By doing so, the patient felt his life was valued, which enabled him to overcome limitations, understand himself better, and learn to face grief and accept himself, thus reaffirming his own worth and significance. Through this caregiving experience, the author deeply realized the various discomforts, fears, and pressures that cancer patients face when confronted with disease recurrence and the prospect of death. These factors significantly impact both the patients and their families. It is hoped that the sharing of this successful case experience will serve as a reference for healthcare professionals in similar patient care scenarios, facilitating the implementation of holistic care.

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