照護一位乳癌患者合併惡性腫瘤傷口之護理經驗

Nursing Experience of a Patient With Breast Cancer Who Suffered From a Fungating Wound

本文為描述一位乳癌合併蕈狀腫瘤傷口的病人與其家庭照顧者，面對發展快速的蕈狀腫瘤傷口與疱疹傷口，引起身心衝擊及焦慮，並間接影響病人及照顧者的生活品質。於2017年12月14日至2018年1月23日期間進行照護，經由直接照顧、觀察、會談與病歷回顧，評估病人的生理需求、身心壓力及家庭照護者的負擔。歸納出以下三個主要健康問題「困難傷口照顧」、「病人心理調適問題」、「照顧者壓力調適問題」，期間使用蕈狀腫瘤傷口實證照護指引，搭配COPE（creativity創造力；optimism樂觀；planning計畫性；expert information專業資訊）協助病人面對心理問題，建立病人及照顧者有效的問題因應方式，降低焦慮、找回信心、增進症狀處理能力、維持病人希望與改善病人身體心像紊亂等。協助個案與家庭照顧者能一同克服傷口照顧困難、改善身體心像並保持希望。本文建議將病人與照顧者視為同一照護單位，讓兩者共同面對傷口、建立照顧信心，進而學會與疾病共存並提升生活品質，藉此護理經驗，期能提供未來護理同仁之實務參考。

This report discusses an experience of taking care of a breast cancer patient with rapidly deteriorating, fungating wounds and herpes simplex virus wounds and describes the physical and psychological effects on the patient and the related decreases in the quality of life of both the patient and her caregivers. Nursing care was implemented from December 14th, 2017 to January 23rd, 2018. Data collection was performed through direct caregiving, observation, interviews, and chart review. Three major problems were identified: difficulties with wound care, psychological distress of the patient, and the coping problems of the caregivers. Based on these problems, nursing interventions were implemented. During the period, fungating wound care guidelines were used to teach the patient and her caregivers the core principles of fungating wound management. Meanwhile, the COPE framework (creativity, optimism, planning, and expert information) was applied to train the patient and her caregivers how to develop problem-solving skills and build self-confidence. Finally, the patient and her family successfully overcame these challenges. The patient was relieved of stress and anxiety, became better able to self-manage her symptoms, sustain hope for the future, and improve her perception of body self-image. We suggested that the patient and her family be considered a single, supportive unit and then helped them cope with the disease and build self-care confidence in order to improve their life quality and to coexist with the disease. We hope that our clinical experience will be taken as a reference by patient caregivers