照護一位乳癌病人合併惡性傷口之護理經驗

Nursing Experience of Caring for a Breast Cancer Patient with a Malignant Wound

10.6740/NTUHJN.202101_17(1).0004

謝念芝(Nien-Chih Shieh)；陳幼貴(Yu-Kuei Chen)

乳癌 ； 惡性傷口 ； 疼痛 ； 無望感 ； breast cancer ； malignant wound ； pain ； hopelessness

臺大護理雜誌

17卷1期（2021 / 01 / 01）

27 - 39

繁體中文

本文主要探討一位三陰性乳癌個案，因癌症進展出現皮膚轉移，此次入院係腫瘤惡性傷口疼痛，以及疾病持續惡化，失去自我控制感而產生無望感。護理期間自2017年12月24日至2018年2月17日，運用Gordon 11項功能性健康型態評估工具，經由直接照護、會談、觀察、身體評估及病歷查閱等收集相關資料，進而確立個案有疼痛、皮膚完整性受損與無望感等健康問題，經由同理傾聽，深入瞭解個案背景、人格特質與人生歷程後，提供個別性衛教，以實證護理方式提供照護，運用跨科部團隊資源，例如麻醉科醫師、傷口造口護理師、心理師、安寧共照護理師等，積極處理疼痛問題，提供合宜之腫瘤惡性傷口換藥方式，教導個案適當情緒表達及心理調適，共同面對後續疾病治療，照護成效為個案疼痛改善、傷口與腫瘤控制穩定後出院返家於門診持續追蹤，未來建議可提供更多相關藝術或美術治療的線上或實體在職教育，讓醫護人員學習更多形式的衛教，增添照護上的創意與選擇性。

This article focuses on a patient with triple-negative breast cancer who developed skin metastasis due to cancer progression. The reasons for this patient's hospitalization were pain of the malignant wound, disease that continued to deteriorate, and a sense of hopelessness caused by the loss of self-control. During the nursing care period from December 24, 2017, to February 17, 2018, Gordon's 11 function health patterns were assessed to collect relevant information. Through direct nursing care, interviews, observations, assessments, and medical records, health problems such as pain, impaired skin integrity, and hopelessness were successfully confirmed. With empathetic listening and understanding of the patient's background, personality, and life course, individual health education was also provided. The patient was treated by evidence-based nursing and interprofessional collaborative practices including collaboration of an anesthesiologist, a certified wound, ostomy and continence nurse (CWOCN), a psychologist and hospice shared care nurse. Combined with active treatment with pain control, appropriate dressing for the malignant wound, education about how to properly express her emotions and psychological adjustment, the patient was able to accept subsequent treatments. In conclusion, this article encourages institutes to provide more online or physical in-service education about art therapy so that healthcare professionals can learn more forms of patient education and increase creativity to develop more options for care.

1. 柯苡含(Yi-Han Ke);王淑麗(Shu-Li Wang);李筠涵(Yun-Han Lee)(2024)。運用醫病共享決策於乳癌抉擇衝突個案之照護經驗。高雄護理雜誌。41(1)。124-134。