照顧一位下咽癌個案行氣切造口術之護理經驗

Nursing Experience of Caring for a Hypopharyngeal Cancer Patient with Tracheostomy

本文探討一位下咽癌男性接受氣切造口術，面對術後身心調適及自我傷口照護之護理經驗。護理期間於2020年3月17日至4月10日，藉由觀察、直接照顧、筆談，運用全人照護評估-身心靈社會模式，確立個案健康問題為溝通障礙、身體心像紊亂與焦慮。個案住院期間正逢新冠肺炎盛行，因應防疫措施，家屬無法隨側關懷陪伴使其內心倍感孤寂。透過主動關心，適時陪伴與鼓勵，引導個案談論面對疾病、正向思考並與家屬攜手幽谷伴行；學習與疾病共融共好的健康態度，漸進式教導氣切照護技巧；引導觸摸造口接受外觀的改變，運用服飾配件修飾氣切造口，增加自我認同與自信；教導使用字卡、書信傳遞及通訊軟體LINE建立新的溝通方式。藉此照護經驗作為日後類似個案參考。

Patients with hypopharyngeal cancer often grapple with the physical and mental adjustments and wound care following a tracheostomy, a pivotal point in their lives. It is crucial to deliver more suitable care to achieve greater care efficacy. Between March 17th and April 10th, 2020, the authors assessed three dimensions of patient care through observation, interviews, examination of medical records, and shared decision-making. Concurrently, amidst the stage of COVID-19 epidemic prevention and infection control, the patient was diagnosed with cancer. Due to restrictions, family members were unable to accompany them and could only offer minimal support. The three dimensions encompassed the relationship between the individual and oneself, others, religious beliefs,“communication disorder,”“body image disturbance,”, and“anxiety”. Throughout the nursing care process, the authors employed one-to-one interviews with active listening skills to establish trust. They provided active care, timely companionship, and encouragement, aligning with positive thinking values to face the difficulties of disease and cope with the new realities of his life. Educational skills training was employed to deepen understanding of disease progression and medical information, keep abreast of treatment progress, teach wound care dressing techniques to enhance self-care abilities, guide tracheostomy care, and gradually help the patient accept bodily changes. Accessories were used to boost self-identity and confidence. The authors employed word cards, letter delivery, and the communication app LINE to establish new communication methods. The result increased patient self-respect and quality of life. This case report may provide a reference for treating similar clinical cases in the future.