困難癒合傷口居家照護的困境與挑戰

Challenges and Dilemmas of Providing Healthcare to Patients in Home Care Settings With Hard-to-Heal Wounds

"困難癒合傷口（hard-to-heal wounds, HHW）乃傷口床（wound bed）因內在或外在因素影響，使其停滯在炎症期或增生期，當傷口床縮合小於40％或超過4星期未癒合者稱之。人口高齡化老年族群因共病性合併HHW人數有攀升趨勢，卻因當前醫療保險制度改變、醫院住院天數縮短，病人須出院返家或入住長照機構照護傷口；然護理人員缺乏系統性的傷口照護教育，對傷口評估與照護技能不足，缺乏實證居家傷口照護指引等，使得居家傷口照護面臨重大的挑戰。HHW不僅造成病人及家屬生理、心理、經濟等層面嚴重衝擊，也引發護理人員的壓力與無力感，不適切處置耗費醫療龐大支出，卻被醫療照護體系忽略它多面向的影響，此現象也被稱為無聲流行病學（silent epidemic）。本文依序說明HHW定義、分析當前全球困難癒合傷口的居家照護現況、面臨的挑戰及策略應用，進而提供居家HHW照護的依據。"

Hard-to-heal wounds (HHW) represent wound beds that are at high risk of stagnating during the inflammatory or proliferative phase because of various internal or external factors. A wound area reduction of less than 40% in 4 weeks is an indicator of HHW. With the acceleration of population aging, an increasing number of older adults are developing various chronic diseases with comorbidities. Although many older adults are affected by HHW, patients are regularly expected to recuperate at home or in long-term care institutions rather than in hospitals because of shortened hospitalization periods and changes in the medical insurance system. The provision of healthcare to patients with HHW in home settings is currently complicated by the lack of systematic nursing education on wound care, the lack of evidence-based guidelines for home wound care, and the inadequate wound care skills of nurses. HHW have major physical, psychological, and economic impacts on patients and their families and increase stress and frustration in nurses. Inappropriate wound care interventions increase medical expenditures and have multifaceted effects that are largely ignored by the medical care system. This phenomenon, which encompasses HHW, has been called a silent epidemic. In this paper, HHW are defined, the current status of home wound healing worldwide is analyzed, the relevant challenges and strategy implementations are discussed, and recommendations for the home care of HHW are provided.