75 論述惡性蕈狀傷口對癌症病人的生理 心理 社會與靈性衝擊 羅淑芬胡文郁 * 惡性蕈狀傷口其惡臭 大量分泌物 出血及疼痛等特性, 對癌症病患生理 心理 社會文化及 靈性層面造成極大衝擊, 甚而影響其健康生活品 質感受 全人照護是緩和醫療照護目標, 然國內 外以全人照護觀點進行此議題探討之文獻付之闕 如, 導致專業人員僅能提供片斷式的傷口照護 本文的目的在增進護理人員對惡性蕈狀傷口認 識, 進而提供病患多面向傷口的照護 內容將涵 蓋惡性蕈狀傷口病因學 病患面臨惡性蕈狀傷口 可能造成生理 心理 社會與靈性層面的改變與 問題, 提出照護建議與策略 透過系統性說明將 有助於護理人員在惡性蕈狀傷口照護之知能, 進 而提升病患的生活品質 惡性蕈狀傷口 傷口照護 身心壓力 1982 10% 15% 62% 24 38 Clark, 2002; Naylor, 2002a Clark, 2002 World Health Organization, 2006 Naylor, 2002b30 90 Laverty, 2003 * 95 10 25 96 9 13 97005 880 03 8572158 637 Chaplin & Curie, 2004 Clark, 2002 Lo Hsu 2006 70 65.7% 46 54.97 13 85 51.4% 18.6% 8.6%12.56
76 Malignant Fungating Wound 60.7% 67.9% 60.7% Chaplin & Curie, 2004 Hampton, 2004; Lo & Hsu, 2006 Lo & Hsu, 2006; Schulz, Triska, & Tonkin, 2002 4 15 Naylor, 2002a Metronidazole DNA Draper, 2005; Wilson, 2005 400mg 200mg Wilson, 2005 Draper, 2005 2 3 Draper, 200510 14 Dowsett, 2002 Hydrogel Dowsett, 2002 Draper, 2005 Draper, 2005 Hampton, 2004 Draper, 2005 Hampton, 2004; Lund-Nielsen, Muller, & Adamsen, 2005 35ml19 0.9% 1.020 Cutting, 2003 Vuolo, 2004 Cutting, 2003 Dowsett & Ayello, 2004 Goode, 2004 Naylor 2002a hydrocolloids dressing
77 alginate dressing Foam dressing Wilson, 2005 Goode, 2004 Hampton, 2004; Naylor, 2002a Adderley & Smith, 2003 1:1,000 adrenaline Wilson, 2005 Naylor, 2002a 55% 95% Naylor, 2001 Dowsett, 2002; Naylor, 2002a Naylor, 2002a; Wilson, 2005 Dowsett, 2002 morphine diamorphinewith hydrogel 0.1% w/w 1mg morphine 1g hydrogel Metronidazole opioids Grocott, 2000; Grocott, Browne, & Cowley, 2005 body realitybody ideal body presentation Bird, 2000 Lund-Nielsen 2005 Lund-Nielsen et al., 2005 Schulz et al.,
78 Malignant Fungating Wound 2002 Bird, 2000 Lund-Nielsen et al., 2005 Bird, 2000 Schulz et al., 2002 Lund-Nielsen 2005 Tan, Waldman, & Bostick, 2002 Hordern 2000 Bird, 2000 American Nurses Association, ANA Popoola, 2003 Tan et al., 2002 McClain Rosenfeld Breitbart 2003 Schulz et al., 2002 Lund-Nielsen 2005
79 Adderley, U., & Smith, R. (2003). Topical agents and dressings for fungating wounds. The Cochrane Database of Systematic Reviews(on line), 1, CD003948. Bird, C. (2000). Supporting patients with fungating breast wounds. Professional Nurse, 15(10), 649 652. Chaplin, J., & Curie, M. (2004). Wound management in palliative care. Nursing Standard, 19(1), 39 42. Clark, J. (2002). Metronidazole gel in managing malodorous fungating wounds. British Journal of Nursing, 11(Suppl. 6), S54 S60. Cutting, K. F. (2003). Wound exudate: Composition and functions. British Journal of Community Nursing, 8(9), 4 9. Dowsett, C. (2002). Malignant fungating wounds: Assessment and management. British Journal of Community Nursing, 7(8), 394 400. Dowsett, C., & Ayello, E. (2004). TIME principles of chronic wound bed preparation and treatment. British Journal of Nursing, 13(15), S16 S23. Draper, C. (2005). The management of malodour and exudate in fungating wounds. British Journal of Nursing, 14(11), S4 S9. Goode, M. (2004). Psychological needs of patients when dressing a fungating wound: A literature review. Journal of Wound Care, 13(9), 380 382. Grocott, P. (2000). The palliative management of fungating malignant wounds. Journal of Wound Care, 9(1), 4 9. Grocott, P., Browne, N., & Cowley, S. (2005). Quality of life: Assessing the impact and benefits of care to patients with fungating wounds. Wounds, 17(1), 8 15. Hampton, S. (2004). Managing symptoms of fungating wounds. Journal of Community Nursing, 18(10), 22 26. Hordern, A. (2000). Intimacy and sexuality for the woman with breast cancer. Cancer Nursing, 23(4), 230 236. Laverty, D. (2003). Fungating wounds: Informing practice through knowledge/theory. British Journal of Nursing, 12(15), S29 S35. Lo, S. F., & Hsu, M. Y. (2006, July). Clinic follow-up of patient with malignant fungating wounds in adults in Taiwan. In Hong Kong Enterostomal Therapists Association, 16 th biennial congress of the World Council of Enterostomal Therapists. Lund-Nielsen, B., Muller, K., & Adamsen, L. (2005). Malignant wounds in women with breast cancer: Feminine and sexual perspectives. Journal of Clinical Nursing, 14(1), 56 64. McClain, C., Rosenfeld, B., & Breitbart, W. (2003). Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. The Lancet, 361(9369), 1603 1608. Naylor, W. (2001). Assessment and management of pain in fungating wounds. British Journal of Nursing, 10(22), S33 S44. Naylor, W. (2002a). Part 2: Symptom self-assessment in the management of fungating wounds. Retrieved December 10, 2006, from http://www.worldwidewounds.com/2002/july/ Naylor-Part2/Wound-Assessment-Tool.html Naylor, W. (2002b). Malignant wounds: Aetiology and principles of management. Nursing Standard, 16(52), 45 56. Popoola, M. M. (2003). Complementary therapy in chronic wound management: A holistic caring case study and praxis model. Holistic Nursing Practice, 17(3), 152. Schulz, V., Triska, O., & Tonkin, K. (2002). Malignant wounds: Caregiver- determined clinical problems. Journal of Pain and Symptom Management, 24(6), 572 577. Tan, G., Waldman, K., & Bostick, R. (2002). Psychosocial issues, sexuality, and cancer. Sexuality and Disability, 20(4), 297 318. Vuolo, J. (2004). Current options for managing the problem of excess wound exudate. Professional Nurse, 19(9), 487 491. Wilson, V. (2005). Assessment and management of fungating wounds: A review. British Journal of Community Nursing, 10(3), S28-S34. World Health Organization. (2006). WHO definition of palliative care [Electronic Version]. Retrieved December 10, 2006, from http://www.who.int/cancer/palliative/definition/en/
80 Malignant Fungating Wound The Physical, Psychological, Social, and Spiritual Impacts of Malignant Fungating Wounds on Cancer Patients Shu-Fen Lo Wen-Yu Hu * ABSTRACT: Malignant fungating wounds (MFW) are accompanied by odor, secretions, bleeding and pain. Cancer patients must not only suffer the physical, psychological, social and spiritual impacts on their disease, but also experience considerable change in health-related quality of life. Palliative health care aims to provide comprehensive services to patients and their families. To date, no study has adopted the standpoint of palliative health care to describe comprehensively the impacts of MFWs on cancer patients, with the result that health professionals are incapable of providing comprehensive care to such patients. This study illustrates the etiology of MFWs, their physical, psychological, social, and spiritual impacts on cancer patients, and wound care strategies. It aims to improve nurses knowledge and understanding of how to assess and identify the etiology of MFWs, in the hope that such knowledge can be applied in clinical practice and as a reference for nurses organizing MFW plans, in order to provide better patient care. Key Words: malignant fungating wound, wound care, psychological and physical stress. RN, MSN, Instructor, Department of Nursing, Tzu Chi College of Technology, & Doctoral Student, Graduate Institute of Nursing, National Taiwan University; *RN, PhD, Associate Professor, School of Nursing, College of Medicine, National Taiwan University. Received: October 25, 2006 Revised: January 10, 2007 Accepted: September 13, 2007 Address correspondence to: Shu-Fen Lo, No. 880, Chien-kuo Rd. Sec. 2, Hualien 97005, Taiwan, ROC. Tel: 886(3)857-2158 ext. 637; E-mail: d92426003@yahoo.com.tw