陪伴一位頰黏膜癌患者面對疾病復發之護理經驗

Accompanied a Nursing Experience of a Patient with Buccal Cancer Facing Disease Recurrence

本文是照護一位頰黏膜癌患者面對疾病復發之護理經驗，個案經歷化學治療、手術，惟後續追蹤檢查確認疾病再度復發，於2017年2月入院治療，因腫瘤壓迫所產生的疼痛不適、對醫療處置的不確定感及疾病失控感產生情緒困擾，致使產生對後續治療的負面影響。照護期間自2017年02月20日至2017年03月02日止。筆者運用生理、心理、社會及靈性之整體性評估，藉由身體評估、會談、觀察及持續性探訪，彙集主、客觀資料，確立之護理問題有癌症疼痛、身體心像紊亂及無望感等護理問題。護理過程中藉由主動關懷及陪伴，與個案建立信任之護病關係，提供個別性與整體性的專業照護，運用背部按摩放鬆技巧、音樂治療及協助維持舒適臥位，減緩癌症疼痛；運用遮蓋技巧，覆蓋口部以維持外觀完整，緩解身體心像紊亂；鼓勵個案參與照護計劃，增加對生活控制感協助復發治療的選擇，運用正念呼吸治療緩解對疾病復發無望感之負面情緒。本文建議護理人員在職訓練課程內容中，納入「培養護理人員對癌症復發病人情緒變化之敏感度、溝通、觀察能力」等訓練課程，培養護理人員對癌症復發病人情緒變化之敏感度、溝通、觀察能力。希望藉此經驗提供護理同仁臨床實務參考。

This article is to care for a patient with buccal cancer who is facing the recurrence of disease. The case has undergone chemotherapy and surgery. However, the disease recurred. He was admitted to hospital, in this period he suffers from tumor compression pain. The emotional uncertainty caused by the medical treatment and the loss of control of the disease has led to a negative impact. The period of care is from February 20, 2017 to March 02, 2017. The author uses physical, psychological, social and spiritual holistic assessments to collect primary and objective data through physical assessment, interviews, observations, and ongoing visits. The nursing problems identified are cancer pain, body disorder, and hopelessness.In the process of care, through active care and companionship, establish a trust relationship with the case, provide individual and holistic professional care, including the use of back massage relaxation, music therapy and help maintain a comfortable lying position, slow down cancer pain; Teaching him to covering the mouth to maintain a complete appearance, relieve the body's mental disorder; encourage cases to participate in the care plan, increase the choice of life control to help relapse treatment, use mindfulness breathing treatment to alleviate the negative feelings of hopelessness of disease recurrence. This paper suggests that the nursing staff should include training courses such as “cultivating nursing staff's sensitivity, communication and observation ability to emotional changes in patients with cancer recurrence＂ in the on-the-job training course, and cultivate the sensitivity of nursing staff to emotional changes in patients with cancer recurrence, communication and observation. ability. I hope to use this experience to provide reference for clinical practice of nursing colleagues.