照護一位初次罹患口腔癌病人之護理經驗

Nursing Experience in Caring for Patients who Suffered from Oral cancer

本文探討一位職業為廚師之口腔癌患者在術後傷口疼痛、焦慮與身體心像改變的護理經驗，護理期間為2014年11月10日至11月26日，筆者透過身體評估、會談、觀察等方式，並運用Gordon十一項功能性健康型態評估個案身、心、社會、靈性等層面的健康問題，確立護理問題。於護理過程中，個案擔心味覺改變影響日後工作，出現焦慮不安及情緒低落，引發筆者想深入探討的動機，藉由完整的傷口與疼痛評估，提供傷口照護；更運用放鬆技巧及轉移注意力，以減緩其疼痛；同時鼓勵個案表達其內心感受，應用陪伴、傾聽、接納與同理心，給予支持鼓勵，並引導正向面對疾病所帶來的改變，於出院前予醫院焦慮憂鬱量表（HADS）測試從13分降為8分。藉此護理經驗，筆者建議日後若照護此類病患時，於疾病確診後可運用跨專業團隊合作，讓病患及家屬能接受與了解團隊的治療方向，以減輕其壓力與焦慮，並提升病患及家屬居家照顧的信心，使其獲得最佳的生活品質：及建議發展出針對癌症病患焦慮的相關評估量表，以利更深入及客觀的評估病患之靈性問題，使護理工作更具專業性。期望藉此護理經驗作為分享，提供同仁參考。 This article will discuss about a chef diagnosed with oral cancer. Post-operatively, the patient suffered from wound pain, anxiety and change of body image. Nursing care commenced from November 10th 2014 to November 26th 2014. The Author uses physical assessment, face-to-face interviews and observational techniques along with Gordon 11 functional health pattern s to assess the physical, psychological, social and spiritual aspect of the patient's health condition to substantiate the liable nursing diagnosis. During the nursing process, the patient became anxious and depressed due to the uncertainty outcomes of the illness to his career as a chef. This prompts the Author to do an in-depth investigation and discussion of this case study. A holistic approach is used in the wound care management of the patient. A complete wound and pain assessment is used in con junction with relaxation and diversion techniques. Furthermore, patient is encouraged to express his feelings and thoughts with empathies and guidance. The support and encouragement given, empowered the patient to face his physical and psychological illness both positively and courageously. Through this nursing experience, the Author feels that using cross- professional teamwork can provide the patients and their family a better understanding of the treatment, which can reduce the pressure and anxiety. Thus, increase the patients and their family's confidence in quality home-care provided. In addition, the author also recommends an implementation of an anxiety assessment form, specifically for cancer patients. This will provide a more in-depth, objective psychological assessment purely for use in professional nursing process. The Author aspired to use this nursing experience as a future recommendation of nursing care for cancer sufferers.

This article will discuss about a chef diagnosed with oral cancer. Post-operatively, the patient suffered from wound pain, anxiety and change of body image. Nursing care commenced from November 10th 2014 to November 26th 2014. The Author uses physical assessment, face-to-face interviews and observational techniques along with Gordon 11 functional health pattern s to assess the physical, psychological, social and spiritual aspect of the patient's health condition to substantiate the liable nursing diagnosis. During the nursing process, the patient became anxious and depressed due to the uncertainty outcomes of the illness to his career as a chef. This prompts the Author to do an in-depth investigation and discussion of this case study. A holistic approach is used in the wound care management of the patient. A complete wound and pain assessment is used in con junction with relaxation and diversion techniques. Furthermore, patient is encouraged to express his feelings and thoughts with empathies and guidance. The support and encouragement given, empowered the patient to face his physical and psychological illness both positively and courageously. Through this nursing experience, the Author feels that using cross- professional teamwork can provide the patients and their family a better understanding of the treatment, which can reduce the pressure and anxiety. Thus, increase the patients and their family's confidence in quality home-care provided. In addition, the author also recommends an implementation of an anxiety assessment form, specifically for cancer patients. This will provide a more in-depth, objective psychological assessment purely for use in professional nursing process. The Author aspired to use this nursing experience as a future recommendation of nursing care for cancer sufferers.