照護一位口腔癌復發併惡性蕈狀傷口病患面對死亡之護理經驗

A Nursing Experience of Caring a Patient with Terminal Recurrent Oral Cancer complicated with Malignant Fungating Wound

本文乃探討一位口腔癌末期個案因惡性蕈狀傷口導致疼痛、惡臭及外觀改變，又因疾病末期面臨到無法預測疾病過程進而產生死亡焦慮之護理經驗，護理期間自於2016年1月15日至2月23日，運用Gordon十一項功能性健康型態評估，及藉由觀察、傾聽、會談等方式收集個案之相關資料，確認個案有「慢性疼痛」、「組織完整性受損」、「身體心像紊亂」及「死亡焦慮」等四個護理問題。在照護過程中，以個案為中心，提供病患及家屬提供完整性照護，緩解個案生理、心理之不適症狀，共同擬定照護計畫，並提供個別性之護理措施，轉移對疼痛的注意力，調整換藥處置，適時鼓勵並接受負向情緒的表達，且整合醫療團隊，運用安寧療護理念，與個案建立良好護病關係，引導個案說出外觀及功能改變的內心感受，提供隱密的環境，主動關懷及傾聽，最後在家屬陪伴之下完成個案後事安排，以達到生命末期之照護，期待透過此照護經驗之分享，提供臨床醫療團隊照護生命末期個案之五全照護之參酌。 This article described nursing process of caring a patient with terminal oral cancer with pain, malodor, and appearance changes caused by malignant fungating wound. The patient also experienced anxiety because of the unpredictable disease progress and facing the fear of death. During the nursing period from 1/15/2016 to 2/23/2016, the author used Gordon's 11 Functional Health Patterns Assessment as the assessment tool, and used other methods, such as interviews and observations, to collect relevant data of the patient. The established main nursing problems were: chronic pain, impaired tissue integrity, body image disturbance, and death anxiety. During the nursing process, the author used tranquility care philosophy and established a good relationship with the patient, actively caring and listening and providing individual care and timely encouraging and accepting the expression of negative emotions. Patient-centered cares were arranged and provided by the integrated medical team. The author also provided support to patient and his family members to alleviate the physical and psychological symptoms and finally achieve the end of life care. This nursing experience provides a reference for caring similar patients.

This article described nursing process of caring a patient with terminal oral cancer with pain, malodor, and appearance changes caused by malignant fungating wound. The patient also experienced anxiety because of the unpredictable disease progress and facing the fear of death. During the nursing period from 1/15/2016 to 2/23/2016, the author used Gordon's 11 Functional Health Patterns Assessment as the assessment tool, and used other methods, such as interviews and observations, to collect relevant data of the patient. The established main nursing problems were: chronic pain, impaired tissue integrity, body image disturbance, and death anxiety. During the nursing process, the author used tranquility care philosophy and established a good relationship with the patient, actively caring and listening and providing individual care and timely encouraging and accepting the expression of negative emotions. Patient-centered cares were arranged and provided by the integrated medical team. The author also provided support to patient and his family members to alleviate the physical and psychological symptoms and finally achieve the end of life care. This nursing experience provides a reference for caring similar patients.