照顧一位女性乳癌併有惡性蕈狀傷口病人的護理經驗

Nursing Experience of a Female Breast Cancer Patient with Malignant Fungating Wounds

惡性蕈狀傷口(malignant fungating wounds, MFWs)常見於癌症晚期，是個複雜且難以癒合的傷口，對病人而言，不論在生理、心理、社會及靈性層面均受困擾。本文敘述一位乳癌末期併有惡性蕈狀傷口病人於2014年5月20至6月6日期間的照護經驗，以生理、心理、社會及靈性層面進行評估，確 立有組織完整性受損、慢性疼痛、身體心像紊亂等護理問題，提供適當的護理措施，如照會傷口照護小組、安寧緩和照護等團隊持續溝通與協調，以傷口照護技巧、止痛藥物調整等處置，並解決傷口惡臭、滲出液及疼痛情形，適時提供關懷及同理心陪伴，增進病人對身體改變之正向看法及接受治療，於病人返家時亦進行電訪持續性的追蹤關懷，以達全人照護理念的照護品質。

Malignant fungating wounds (MFWs), which are commonly seen in advanced cancer patients, are complex and unlikely to heal completely. They can result in extreme distress to patients and their families and cause limitations in patients’ daily life and social relations. This paper describes the nursing experience of caring for a patient with advanced breast cancer and MFWs. During the nursing period from May 20 to June 6 in 2014, we conducted a holistic assessment incorporating physical, psychological, social, and spiritual aspects. The health problems included impaired tissue integrity, chronic pain, and disturbed body image. Intervention strategies included providing wound care for managing wound odor, exudates, and pain, establishing a good nurse-patient relationship by giving emotional support and acceptance, providing the patient and families with related treatment information, and further encouraging them to participate in decision-making and the receiving of treatment. We improved the patient’s positive thinking on body image change during the nursing process and conducted follow-up telephone interviews and care after patient discharge, thereby achieving holistic health care, and ultimately improving the quality of care.