一位初診斷鼻咽癌女性病人之門診照護經驗

The Outpatient Care Experience of a Female Patient with Newly Diagnosis of Nasopharyngeal Carcinoma

10.6880/TJON.202406_24(1).04

顏舒涵(Sue-Han Yan)；陳彥伶(Yen-Ling Chen)；寇蕙薐(Hui-Ling Kou)

鼻咽癌 ； 口腔黏膜完整性受損 ； 皮膚完整性受損 ； 無望感 ； nasopharyngeal carcinoma ； impaired oral mucous membrane integrity ； impaired skin integrity ； hopelessness

腫瘤護理雜誌

24卷1期（2024 / 06 / 01）

43 - 53

繁體中文;英文

本文探討一位初診斷鼻咽癌女性病人，於門診接受同步化學與放射線治療之護理經驗。筆者於2021年12月1日至2022年1月19日之門診照護期間，運用Gordon十一項健康功能型態評估，藉由觀察、會談、電訪等方式蒐集資料，確立個案有「口腔黏膜完整性受損」、「皮膚完整性受損」與「無望感」等三項健康問題。筆者為門診護理師，於個案罹癌初期，以關懷與同理，建立信任護病關係，治療期間先教導以生理食鹽水等溶液進行口腔照護，錄製清潔技巧影片，作為居家口腔護理之參考，依口腔黏膜破損等級給予不同衛教措施；教導放射線皮膚居家照護原則，提供個別性皮膚傷口護理；連結團隊資源，參與治療計畫與提供癌症相關資源，給予正向回饋，減輕個案因面對罹癌與治療不確定性所產生的無望感，勇敢面對治療產生的生理困擾與罹癌的心理衝擊，順利完成治療。期望藉此分享具護理獨特性之照護過程，作為未來臨床照顧此類個案之參考，提升照護品質。

This article discussed my nursing experience of a 46 year-old female patient with newly diagnosed nasopharyngeal carcinoma cT2N1M0 who received concurrent chemoradiotherapy in our outpatient clinic at cancer hospital. During the period of treatment course from December 1, 2021 to January 19, 2022, I used Gordon Eleven Health Functional Patterns Assessment to collect clinical data with three different methods. There were observations, interviews, and telephone interviews. After comprehensive evaluation the patient was identified to have three problems with regards to regarding her treatment related adverse events including "impaired oral mucosa integrity," "impaired skin integrity," and "hopelessness". As a nurse at outpatient clinic, I showed a proactive, caring and empathic attitude to the patient at the diagnosis of cancer in order to establish a trusting nurse-patient relationship. During the course of treatment, I taught the patient to use some solutions such as saline to keep oral hygiene and recorded videos regarding caring skills of oral cavity, which could be a demonstration for the patient to learn at home. I presented several different hygienic measures to the patient according to the severity of oral mucosa damage. I also shared some nursing principles of radiation skin with the patient, provided information about individualized wound care, participated in the treatment planning and offered resources to keep her quality of life. During cancer treatment I gave positive supports and affirmations to alleviate of the patient hopelessness which was caused by the uncertainty of cancer and treatment. Besides, I encouraged the patient to face the physiological changes caused by the side effects of treatment and the psychological impact of cancer bravely until completion of whole treatment course. Hopefully, my sharing of this unique nursing experience will serve as a reference for clinical care of such cases in the future and improve the overall quality of care.