照護一位初次罹患舌癌女性患者術後之護理經驗

Postoperative Nursing Experience Obtained Through Caring for a Female Patient Newly Diagnosed with Tongue Cancer

本文敘述一位年輕女性初次罹患舌癌術後之護理經驗。照護期間為2020年5月23日至6月3日，透過觀察、傾聽、筆談、身體評估等收集資料，採用Gorden十一項功能性健康評估工具，確立個案有呼吸道清除功能失效、急性疼痛、潛在危險性感染、身體心像紊亂及睡眠型態紊亂等護理問題。提供個別性之護理計畫；教導有效咳嗽方式協助痰液排出以減少不適感；提供藥物及轉移注意力來緩解疼痛；初期因身體外觀改變不願意參與口腔清潔護理，透過護理措施與個案建立信任感使其主動參與傷口護理並維持舒適與清潔，引導表達對身體外觀改變之感覺受，讓個案重新拾回自信心，早日重返職場生活。建議日後臨床上能編制口腔癌個案管理師，使個案在出院後可以得到持續性照護，藉此照護經驗，提供臨床照護類似個案之參考。

This article describes the postoperative nursing care provided to a young woman newly diagnosed with tongue cancer. The care period was from May 23 to June 3, 2020. Data were collected through observation, oral recollection, written interviews, and physical assessment. Gordon’s 11 functional health patterns were used to determine the patient’s most critical nursing needs, which included ineffective airway clearance, acute pain, risk of infections, distorted body-image, and disturbed sleeping pattern. An individualized care plan was formulated. The nurses taught effective coughing methods to help the patient expel sputum to reduce discomfort. Medication was provided and patient attention was diverted to relieve pain. The patient was initially unwilling to receive oral hygiene care due to changes in body appearance. The nurses thus obtained the patient’s trust through nursing measures, enabling the patient to actively participate in her wound care to maintain comfort and cleanliness. The nurses also guided the patient to express her feelings about her changes in body appearance, facilitating restoration of the patient’s self-confidence and accelerating her return to her workplace. We recommend that oral cancer case managers be established in clinical practice so that future patients can receive continuous care after discharge. This care experience may serve as a reference for clinical nursing care in similar cases.