照顧一位胰臟癌末期病人接受安寧療護之護理經驗

Nursing Experience of a Patient with Terminal Stage Pancreatic Cancer Receiving Hospice Care

本文是探討一位罹患頰黏膜癌個案接受人工皮瓣重建手術所引起身心反應之護理經驗。護理照護期間自2012年7月17日至26日，以Gorden十一項健康功能型態評估為架構，經由訪談、觀察、直接照護、會談與病歷查閱等方式收集主、客觀資料，確立個案有焦慮、口腔黏膜改變及身體心像紊亂等健康問題。護理過程中擬定個別性護理計畫，鼓勵個案表達出內心對疾病與治療的擔憂、焦慮，術後讓個案與家屬一同檢視傷口，藉由傷口照護衛教，並定期口腔清潔護理，減少口腔異味及降低傷口感染；提供腫瘤切除及重建的資訊釐清其疑問與不安。術後易有自尊低落及身心適應問題，協助建立正向思考與認同感，預防社交隔離，提升照護頰黏膜癌重建病患之術後護理照護品質。

This report describes the nursing experience of a patient with physical and psychological reaction to skin reconstruction surgery for buccal squamous cell carcinoma. Gordon's 11 Function Health Patterns Assessment criteria were used to evaluate the patient from 17 to 26 July, 2012. The health problems included 1) anxiety, 2) change in the oral mucosa, and 3) body image disturbance. The author provided complete care plans during the nursing period. The patient and his family received education on wound care, with emphasis on cleaning and caring for the infection and improving the oral odor. The author also provided the information on tumor resection and artificial skin reconstruction, as well as suggestions for physical and psychological adaptation after surgery to alleviate his uncertainty and anxiety. Helping the patient to establish positive thinking and identity enabled him to return to society; this approach improves nursing care for patients with buccal squamous cell carcinoma.