運用安寧療護照護一位口腔癌末期合併腫瘤蕈狀傷口之照護經驗

Nursing Experience for an End-Stage Oral Cancer Hospice Patient with Fungating Wound

10.6530/YYN.201911_13(3).0008

林靖雅(Ching-Ya Lin)；施秀鈴(Hsiu-Ling Shih)；張煦婕(Hsu-Chieh Chang)

口腔癌 ； 腫瘤蕈狀傷口 ； 安寧療護 ； oral cancer ； malignant fungating wound ； hospice care

源遠護理

13卷3期（2019 / 11 / 01）

58 - 64

繁體中文

本文探討運用安寧療護理念照護一位口腔癌末期病人之經驗，個案為47歲未婚男性，2009年確診為口腔癌後接受腫瘤切除手術，並陸續行化學及放射治療，因腫瘤蕈狀傷口持續擴大、疼痛控制不佳及治療成效不佳，使個案擔心疾病變化快速及面對案姊不捨情緒，導致面對死亡時產生焦慮情緒，故引發筆者探討動機及選案理由。照護期間自2016年2月29日至2016年3月10日，運用生、心、社、靈四層面進行整體性評估，藉由病歷查閱、會談、團隊討論等方式收集資料，確立健康問題為組織完整性受損、慢性疼痛、死亡焦慮，護理期間運用安寧全人、全家、全隊、全程之四全照護理念，並改善腫瘤蕈狀傷口異味及出血，給予適當疼痛控制及芳香療法等輔助治療，以緩解個案不適感受，過程中適時教導家屬傷口照護之技巧，並藉由陪伴、關懷個案及家屬，以降低個案焦慮之情形，透過個別性之護理措施提升個案生命品質，達到身、心、靈平安而得以善終，家屬得以善別。

This article shares the experience of hospice nursing care of a 47-year old with an end-stage oral can¬cer patient. This was a single male who was diagnosed with oral cancer in 2009. He received chemotherapy, radiation therapy and tumor resection surgery. However, his fungating wound expanded and was extremely painful despite extensive wound management. The patient was in grief for the fast deterioration and the sad¬ness showed by his sister. The caring period was from February 29 to March 10, 2016. Data was collected through physical evaluation, medical record review, observation, listening, and therapeutic conversations. Data was evaluated in physical, psychological, social and spiritual aspects for assessment of holistic health. The major health problems identified were impaired tissue integrity, chronic pain, and anxiety of anticipat¬ing death. Through the hospice concepts of the whole person, whole family, whole course, and whole team, the team implemented fungating wound care and pain management to improve the bleeding, odor and com¬fort. The team also provided patient and family teaching on wound care skills, companionship, and caring to reduce his anxiety. The quality of life improved by individual nursing care to achieve physical, mental, spiritual peace and good death.

1. 黃文翰,鄭逸如,楊于婷,張琦郁,黃士哲(2017)。如何面對臨終的死亡焦慮—誰該為自身的死亡負責？。安寧療護雜誌，22(2)，202-212。
   連結：
2. Baykul, T.,Yilmaz, H. H.,Aydin, U.,Aydin, M. A.,Aksoy, M.,Yildirim, D.(2010).Early diagnosis of oral cancer.Journal of International Medical Research,38(3),737-749.
3. French, C.,Greenauer, N.,Mello, C.(2017).A multifactorial approach to predicting death anxiety: Assessing the role of religiosity, susceptibility to mortality cues, and individual differences.Journal of Social Work in End-of-Life & Palliative Care,13(2-3),151-172.
4. Glare, P. A.,Davies, P. S.,Finlay, E.,Gulati, A.,Lemanne, D.,Moryl, N.,Syrjala, K. L.(2014).Pain in cancer survivors.Journal of Clinical Oncology,32(16),1739-1747.
5. Kim, Y. C.,Ahn, J. S.,Calimag, M. M.,Chao, T. C.,Ho, K. Y.,Tho, L. M.,Bhagat, A.(2015).Current practices in cancer pain management in Asia: A survey of patients and physicians across 10 countries.Cancer Medicine,4(8),1196-1204.
6. Merz, T.,Klein, C.,Uebach, B.,Kern, M.,Ostgathe, C.,Bükki, J.(2011).Fungating wounds- Multidimensional challenge in palliative care.Breast Care,6(1),21-24.
7. Probst, S.,Arber, A.,Faithfull, S.(2013).Malignant fungating wounds: The meaning of living in an unbounded body.European Journal of Oncology Nursing,17(1),38-45.
8. 李雅萍,黃馨葆,蔡兆勳,陳慶餘,邱泰源(2012)。癌症疼痛控制的現況。安寧療護雜誌，17(1)，62-75。
9. 卓芷聿(2010)。臨床芳療在癌症病患身心靈照護的輔助角色。腫瘤護理雜誌，10(2)，9-22。
10. 胡文郁,陳宛榆,羅淑芬,陳書毓,黃翰心,陳幼貴(2011)。成人癌症疼痛臨床照護指引。瘤護理雜誌，11，87-127。
11. 黃傳永(2012)。藝術治療運用在失落悲傷調適之探討。台灣心理諮商季刊，4(2)，22-41。
12. 衛生福利部國民健康署（2019）．107年國人死因統計結果．取自https://www.mohw.gov.tw/cp-16-48057-1.html
13. 鄭如芬,林雅卿,黃百后,韋至信,孫嘉玲(2014)。癌症末期病人靈性照護模式。護理雜誌，61(6)，93-97。