照顧一位口腔癌病人傷口癒合不良導致身體心像紊亂之護理經驗

Nursing Experience of Body Image Disturbance of an Oral Cancer Patient with Poor Wound Healing

本篇個案報告描述照顧一位口腔癌行放射線及化學治療導致下頷骨組織壞死病人，反覆入院拔牙及清創後傷口癒合不良產生身體心像紊亂的護理經驗。照護期間為2019年7月29日至8月06日，藉由實際照護、觀察及會談收集資料，並運用Gordon十一項健康功能型態進行評估，確立其健康問題為組織完整性受損、疼痛及身體心像紊亂。筆者運用護理過程提供個別性的口腔清潔護理指導，加強個案對疾病的認知和傷口照護的重要性，並在旁陪伴與傾聽其心路歷程及困擾，轉移個案對傷口疼痛的注意，同時引導個案每日觀察傷口逐漸好轉的進展，使其勇於面對疾病所帶來的改變，藉由正向反思自我價值找回自信及與外界交流及相處的能力。期望藉由此護理經驗，提供臨床護理人員照顧其他類似個案之參考。

The article described the nursing experience of caring an oral cancer patient undergoing radiation and chemotherapy, which caused osteonecrosis of the lower jaw. The patient had body image disturbance and repeated admission to the hospital due to poor wound healing after tooth extraction and debridement. During the nursing period from July 29th to August 6th of 2019, Gordon's eleven functional health patterns were used to collect data through direct care, observation, and conversations. The identified health problems included impaired tissue integrity, pain, and body image disturbance. During the process of nursing care, we provided individualized oral cleaning guidance, enhanced her understanding of the illness and emphasized the importance of wound care. While she was expressing her feelings, we adopted the techniques of listening and accompaniment to shift her attention away from pain. In addition, we guided her to observe the wound healing progress every day and faced the changes brought about by disease. We encouraged her to retrieve self-confidence, self-worth and the ability to communicate and get along with others by practicing positive thinking. Through sharing this nursing experience, we hope to provide nursing staff with a reference for providing care to similar patients.