照護一位初診斷口腔癌病人家庭角色改變之護理經驗

Nursing Experience for a Newly Diagnosed Oral Cavity Cancer Patient and the Role of the Family as Care Providers

本文為照護一位初診斷口腔癌病人因擔心疾病進展、經濟與照顧人力，及其家庭照顧角色改變而產生重大負荷之護理經驗。於護理期間發現個案因罹病前、後的身心變化及家庭成員角色任務改變難以調適，因而引發多種負向情緒反應。於2017年4月15日至4月30日主要照護期間，運用Gordon十一項健康功能型態進行評估，經由觀察、會談、傾聽、身體評估及病歷查閱等方式收集資料，確立個案有呼吸道清除功能失效、身體心像改變及危害性家庭因應能力等健康問題，於照護過程中運用噴霧及藥物治療降低痰液黏稠度、教導深呼吸咳嗽技巧，以利痰液咳出，予重建自我價值面對顏面外觀改變，並藉由跨領域團隊合作，各專業醫護人員提供個別性及返家後照護資訊，協助調適個人及家庭成員角色任務改變，並可銜接後續出院準備服務，使病人及其家庭獲得持續性、可信賴性的照護，進而提升良好整體性之照護品質。

This paper discusses the experience of administering nursing care for a newly diagnosed oral cavity cancer patient. The patient was concerned with the development of cancer, the financial situation and care providers, and the role of the family as care providers. The nursing period was between April 15th to April 30th , 2017. The patient was assessed using Gordon's 11 functional health patterns, and data collection was carried out through observation, conversation, listening, physical assessment and medical record inspection. The patient had healthy issues with ineffective airway clearance, body image change, and compromised family coping. The nursing care team administered a series of solutions, including the use of sprays and other medications to lower the viscosity of mucus secretions, the instruction of mucus clearance techniques such as deep breathing and coughing, in addition to reconstruction of the patient's body image confidence to cope with change of facial appearance. The nursing care team also collaborated with teams across different fields so that the patient received customized and post-hospitalization care while transiting back to the patient's home of origin, and assistance in dealing with the changes in roles changes of the patient and family members. The preparatory services for post-hospitalization administered by the nursing care team ably created sustainable and trustworthy circumstances for the patient and the patient's family, and effectively improved the overall quality of care.