運用醫病共享決策於乳癌抉擇衝突個案之照護經驗

本文描述照護一位乳癌患者併有腦轉移及蕈狀腫瘤傷口病患之護理經驗，筆者照護期間為2020年5月21日至6月4日，運用生理、心理、社會、靈性等四大層面進行整體性評估，以直接照護、觀察、會談、傾聽、團隊討論及病歷閱讀的方式收集資料。確立主要健康問題有：確認個案有組織完整性受損、身體心像紊亂、抉擇衝突等健康問題。在照護過程中教導並示範自我傷口照顧方式，有效控制傷口出血、潰爛等症狀，並運用精油滴在衣物或小紗布上減少異臭味之產生。照護過程中，多次探望並傾聽個案及家屬對手術療法抉擇衝突時內心的煎熬，同時尊重個案及家屬選擇的治療意願，照護團隊提供具實證依據的資訊，讓個案及家屬做最佳選擇，減少其後悔與衝突感受。提供疾病照護相關的資源與資訊，讓個案得到個別性的整體照護，協助改善生活品質及促進傷口舒適。筆者期望藉由本文之護理經驗，提供臨床同仁照護類似個案的參考，以提升病人的照護及生活品質。

關鍵字

乳癌；惡性腫瘤蕈狀傷口；抉擇衝突；醫病共享決策

並列摘要

This paper records the nursing experience for a breast cancer patient with brain metastases and a fungating tumor wound. The author took care of the patient from May 21st to June 4th, 2020 and performed holistic assessment on the physical, psychological, social, and spiritual levels. Data were collected by means of direct nursing, observation, interviews, listening, group discussion, and reading of the medical records. Main health problems confirmed include impaired tissue integrity, body image disturbance, and decisional conflict, etc. During the nursing process, the following care methods are instructed and demonstrated: self-care of wounds, effective control of wound bleeding and ulcer, and mitigation of peculiar and stinky odor by applying essential oil on clothing or small pieces of gauze. During the nursing process, a number of visits were made to the patient and her family to hear their frustration about the decisional conflict when deciding on the surgical treatment, and the patient's and her family's choice of treatment was respected. The nursing team also provided empirical information to the patient and her family as the basis for making the best decision, so that regretful and conflicting feeling could be mitigated. The patient was provided with nursing-related resources and information, in order that she could get holistic individual care to help improve the quality of life and promote wound comfort. The author expects that the nursing experience in this paper can provide a reference for fellow clinical staff when caring for patients with similar condition to improve the quality of nursing care and quality of life for patients.

並列關鍵字

breast cancer ； malignant fungating wounds ； decisional conflict ； shared decision making

參考文獻

李婉菱、張慈惠、黃嗣棻（2021）．醫病共享決策之概念與實務．台大護理雜誌，17(1)，5-13。https://doi.org/10.6740/NTUHJN.202101_17(1).0002

邱秀渝（2016）．癌症病人的治療決策過程．護理雜誌，63（5），12-18。https://doi.org/10.6224/JN.63.5.12

楊榮森、楊宗翰（2021）．手術之醫病共享決策．台灣醫學，25（1），111-117。https://doi.org/10.6320/FJM.202101_25(1).0011

鄭旭倩、陳宜珊（2020）．照顧一位乳癌末期合併腫瘤蕈狀傷口病人之護理經驗．台大護理雜誌，16（2），53-63。https://doi.org/10.6740/NTUHJN.202007_16(2).0006

謝念芝、陳幼貴．（2021）．照護一位乳癌病人合併惡性傷口之護理經驗．台大護理雜誌，17（1），27-39。https://doi.org/10.6740/NTUHJN.202101_17(1).0004

主題瀏覽