運用跨團隊模式照護一位初次罹患口咽癌病人術後之護理經驗

本文探討一位罹患口咽癌患者，初次面臨癌症診斷及治療過程，於術後歷經治療階段引發生理不適與心理衝擊之護理經驗。護理期間為2019年04月13日至04月30日，筆者藉由直接照護、觀察、傾聽、筆談及身體評估等方式收集資料，並運用羅氏適應模式進行整體性評估，確立個案有呼吸道清除功能失效、急性疼痛、組織完整性受損及焦慮之健康問題。照護過程中與個案及家屬建立良好護病關係，運用跨團隊照護模式，建立個別性整合照護計畫，提供肺部護理措施促進排液排出，成功移除氣切套管；因術後傷口導致疼痛，運用疼痛評估量表，除調整藥物使用外，並提供個別性護理措施緩減疼痛，有效分散注意力及舒緩不適症狀；於組織完整性受損方面，口腔及傷口護理介入，採漸進式回覆示教，增進個案及案妻學習意願；藉由傾聽及陪伴，同感心支持，鼓勵表達內心感受，提供疾病照護訊息，一同參與照護計畫，強化自我照顧能力，並運用放鬆技巧減緩焦慮情緒，透過癌友支持重拾信心，勇於面對疾病與癌共存，回歸生活。未來建議建構各團隊資訊平台，掌握病人後續狀態，以達到全方位照顧。

關鍵字

口咽癌；跨團隊模式；羅氏適應模式；護理經驗

並列摘要

This article described postoperative care experience of a first-diagnosed oral carcinoma patient who suffered from physical discomfort, disease related stress, and cancer related treatment. The nursing period was from April 13th to 30th, 2019 in which data were collected through multidisciplinary care, observation, active listening, written interviews, and physical assessment. Appling the Roy's Adaptation Model, major health problems were identified, including: ineffective airway clearance, acute pain, impaired tissue integrity and anxiety. With an established nurse-patient relationship, the focus of nursing care was on empathy through active listening, companionship, and positive encouragement. A multidisciplinary team approach was utilized to provide lung and airway care that ultimately the patient's sputum and oral discharge were reduced and his tracheotomy tube could be successfully removed. Postoperative wound's pain was managed mostly by non-pharmacological therapeutic measures which attention distraction was effective in addition to pain medicine. In terms of tissue integrity, the patient and his wife were provided accurate information about the disease in order to improve self-oral and wound care. During the nursing period, the team approach assisted the patient regain confidence to face the coexistence of cancer, allowed the patient and his family to participate in caring process, strengthened self-care skills, reduce anxiety by relaxation techniques, and inducted the patient to relevant cancer foundation. Furthermore, a multidisciplinary information platform is suggested for holistic care and disease monitoring after oropharyngeal cancer patients discharge and return to their community.

並列關鍵字

Oropharyngeal Cancer ； Multidisciplinary team approach ； Roy's Adaptation Model ； ineffective airway clearance ； acute pain ； impaired tissue integrity and anxiety

參考文獻

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運用跨團隊模式照護一位初次罹患口咽癌病人術後之護理經驗

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