運用安寧緩和療護照顧一位口腔癌末期病人之護理經驗

Nursing Experiences of the Hospice and Palliative Care to a Terminal-Stage Oral Cancer Patient

江怡嫻 ； 姚靜宜 ； 邱燕甘

《腫瘤護理雜誌》 11卷2期 (2011/12) Pp. 75-86

https://doi.org/10.6880/TJON.201112_11(2).07

摘要

本文探討一位口腔癌末期病人，面對疾病復發無法進行治癒性治療，轉而接受安寧緩和療護的護理過程。護理期間自2008年9月17日至10月6日，筆者透過直接照護、身體評估、觀察、會談等方式，運用Gordon十一項健康功能型態進行整體性評估及資料整合分析後，確立病人有疼痛、焦慮及心靈困擾等四項健康問題。筆者於護理過程中藉由正確的疼痛評估，給予止痛藥物控制及給予另類療法如按摩、冷熱療法減輕病人的疼痛不適。藉由完整的傷口評估，提供病人合適的換藥方式及配合精油除臭及止血藥物使用，減輕病人傷口惡臭及出血。透過不斷溝通、傾聽、同理病人及家屬的感受並衛教傷口換藥技巧、傷口出血處理步驟及回覆示教；提供諮詢電話等措施，增加病人的自我照顧能力，降低焦慮。教導生命回顧，使病人心靈平靜最後達到協助病人完成返家的心願。期許此護理經驗能夠提供護理同仁往後照護類似病人之參考。

關鍵字

安寧緩和療護 ； 口腔癌 ； 末期病人

並列摘要

This case report describes nursing experiences of the hospice and palliative care to a terminal-stage patient with oral cancer, who experienced cancer relapse that was incurable, and therefore was transferred to the hospice and palliative care unit. We took care of this patient from September 17 to October 6, 2008 using direct care, physical health assessment, observation, and interviews. The author collected and organized the assessment data based on Gordon's 11 functional health patterns and performed a thorough data integration and analysis. Patient was later diagnosed and suffered from four health problems that included pain, tissue integrity impaired, anxiety, and mental and emotional distress. During nursing care process, the author administered the analgesic medication based pain assessment, and offered alternative therapy such as massage and cold-hot therapy to mitigate the patient's discomfort and pain. Through a thorough wound assessment, an appropriate wound dressing was selected for the patient, whose open wound was also treated with styptic, antiseptic and anti-hemorrhagic medication to mitigate the malodor and bleeding. In addition, the authors made efforts to communicate consistently, listen to, understand and empathize with the patient and family's feelings and perspectives. The authors educated the families the skills of wound dressing change and the methods to manage the bleeding wound, and provided counseling through follow-up phone calls to continue nursing care. In this case report, the provision of support and education for the patient and family could increase the patient's competence for self-care, and reduce their anxiety. Finally, the patient achieved peaceful mind and spirituality through life review, and fulfilled the patient's wish to going home. It is expected that the unique nursing experiences could provide a reference for nurses on how to provide end-of-life care in hospice and palliative units.

並列關鍵字

hospice and palliative care ； oral cancer ； terminal-stage patient