照護一位舌癌病人接受重建皮瓣手術之護理經驗

Nursing Experience in Caring for a Patient with Tongue Cancer Undergoing Flap Reconstruction Surgery

本文是探討一位年輕男性因舌癌接受腫瘤切除、皮辦重建手術，協助個案面對顏面外觀及功能改變與身心調適之護理經驗。照護期間為2022月03月31日至04月14日，運用Gordon十一項功能性健康型態評估，藉由實際照護、觀察及會談收集資料，確立護理問題有急性疼痛、口腔黏膜改變、焦慮、身體心像紊亂。照護過程中藉由陪伴與個案建立信任護病關係，加強個案與家屬對疾病的認知，提供個別化與整體性照護，透過與醫療團隊討論調整用藥及非藥物治療措施，以緩解傷口疼痛情形；教導個案及案妻口腔清潔技巧及促進口腔黏膜復原；引導其表達外觀改變之內心感受及困擾之事，減輕焦慮適時給予正向心理支持與鼓勵，提供病友分享經驗，以正向態度接受自我及接受身體結構改變。口腔癌病人因術後身體結構變化之事實易情緒起伏較大及無法接受，建議在照顧過程多給予關懷、傾聽及同理，藉由院牧關懷師與團隊給予支持，使其能面對術後身體心像改變歷程及增加社會適應能力，藉此分享日後照護此類病人之參考。

This article discussed about nursing experience of assisting a patient, who had tongue cancer history and accepted the surgery of tumor excision and flap reconstruction , to confront the change of facial appearance and function and to adjust his mood. The nursing period was from 2022/03/31 to 2022/04/14.Gordon 11 function health patterns was applied. According to the care, observation , and conversations, there were nursing issues like acute pain, change of oral mucous, anxiety, and nervous. By accompanying the patient, we built the trust in nurse-patient relationship. We enhanced the patient and his family's understanding of diseases and provided individual and holistic health care. We relieved the wound pain by adjusting therapy including medicine and non-medicine through discussing with medical team. We tough him and his wife about cleaning method for oral care and recovery of oral mucosa. We lead him up to talking about his feeling and confuse and gave him positive mental support to reduce his anxiety. Sharing Experience with other patients develop a positive attitude and accept the condition of physiological change. The patients with oral cancer will be moody due to physiological change. We suggest that giving more solicitude, listening, and empathy in care. The Pastors and medical teams support the patient to take on the challenge of mental problems and adapting to society. We shared the experiences of caring these patients as a reference.