一位癌末惡性蕈狀傷口個案面臨死亡焦慮之護理經驗

Nursing Experiences of the Malignant Fungating Wound in a Terminal Cancer Case Facing Death Anxiety

本文主要探討一位舌癌末期個案，其惡性蕈狀傷口合併慢性疼痛及死亡焦慮的照護經驗。筆者於2007年1月8日至2月15日期間藉由整體性護理評估及筆談方式收集資料，確立個案有慢性疼痛、組織完整性受損、死亡焦慮等問題；針對慢性疼痛問題，採睡涼水枕、頭頸部淋巴及穴位按摩、音樂及精油輔助療法等措施來緩解個案的疼痛症狀；針對組織完整性受損問題，於傷口護理時，選擇生理食鹽水濕紗和furacin紗布進行傷口濕敷，以緩解傷口出血，並於外層敷料加入茶樹精油緩解傷口惡臭，同時運用人工皮及低過敏膠帶來保護傷口周圍皮膚。此外，筆者透過傾聽和同理個案的死亡焦慮，及運用懷舊治療及生命回顧來肯定個案自我價值感，再加上牧靈人員增強其天主信仰，並藉由醫護團隊成員和家屬共同協助個案準備好面對死亡的過程，以完成個案返家善終之心願。

This paper is to explore the caring experiences of the malignant fungating wound with chronic pain and death anxiety in a terminal tongue cancer patient. The author collected data by using comprehensive assessment and pencil-talking from January 8 to February 15, 2007 and identified chronic pain, impaired tissue integrity, and death anxiety of the case problems. For chronic pain, sleeping pillow with cold water, massage lymph and acupoints of head and neck, music and aroma therapy were used to release symptoms of the case pain. For impaired tissue integrity, during wound care, normal saline and furacin gauzes were used to wet-packing to release wound bleeding, and tree oil aroma put into the covering gauze to release the smelling, and used duoderm and low-allergic tapes to protect the skin around the wound. Additionally, the author used listening and empathy to relieve the patient’s death anxiety, applied reminiscent therapy and life-review to affirm the case self-value, enhanced catholic religion by the priest, and prepared the case to face the death process through the assistants of medical and nursing professionals with family, and complete her wish of good death at the home.