影 / 護理耕耘18年!奇美醫院護理師陪伴腫瘤病人走完人生最後一哩路
2023-06-12 記者 蘇旋/報導
奇美醫療財團法人奇美醫院護理部8A(血液腫瘤科病房)小組長吳玉琳在護理田上已耕耘了18年，回想一開始選擇護理，跟多數人一樣是家人的建議，理由是「畢業後工作穩定」。吳玉琳畢業後到奇美醫院面試時，當時志願科別寫了三個內科病房，但從來沒想過會到血液腫瘤科(8A)病房，畢竟這是從未在實習端就接觸的科別。剛走入臨床是惶惶不安的，看著病人得知罹癌時的震驚、化學治療過程的緊張無助、最後接受了醫療有其極限的事實，接續著安寧緩和醫療介入，在簽署不施行心肺復甦術(DNR)同意書的掙扎後，終須面臨死別的哀傷輔導。奇美醫院護理部8A(血液腫瘤科)病房小組長吳玉琳說道：「這些年，病人用生命讓我體會，這是個無法改變的生命歷程，但能在照護過程中，傾聽到病人及家屬心中的想法，陪伴共同度過生命最後一哩路，他們對我的信任感，是其他工作無法比擬的，也帶給我最大的成就感。」
護理部8A(血液腫瘤科)病房小組長吳玉琳生活照
血液腫瘤科病房入住的都是罹癌的病人，除了固定時間需施打化療藥物，會有5至14.5%病人會發生惡性蕈狀傷口，這些傷口是無法癒合的。腫瘤傷口的形成是因為癌細胞增生，造成組織呈現蕈狀或浸潤式生長，進而使腫瘤蕈狀傷口穿透皮膚或轉移至皮膚，宛如體內潛藏的迅猛龍，啃食病人殘弱的身體，吞噬僅存的生命力。
護理部8A(血液腫瘤科)病房小組長吳玉琳工作照
腫瘤蕈狀傷口通常會出現惡臭、大量滲液、出血及疼痛，這些不適症狀常常造成病人的身心負荷加重，感到衝擊或自卑繼而導致社交退縮，而家屬對傷口的恐懼及照護負擔也隨之增加，護理師面對複雜多變的腫瘤蕈狀傷口挑戰時，就是要盡最大的能力，讓病人及家屬在面對生命威脅之際，比現在過得更好。
護理部8A(血液腫瘤科)病房小組長吳玉琳工作照
吳玉琳說明，記得多年前照護過一位口腔癌病人，病人傷口惡臭嚴重、換藥時出血頻繁，當換藥時都讓自己很擔心會突然大出血，一直到病人離世，病人的傷口仍未改善。那時病人太太說過，這個傷口讓病人很痛苦、面目全非的樣子不敢讓親朋好友看到。太太問她能不能想辦法讓病人沒有傷口的離開？那時，吳玉琳小組長在病人的傷口上覆蓋人工皮敷料，雖然不知道是否是最合適的，但卻是最後能為病人做的事。當家屬看到病人傷口貼上人工皮敷料，猶如象徵傷口已痊癒，激動感謝的神情表露無遺，除了撫慰家屬的心，也觸動了自己的內心深處。因為這個照護經驗，讓我知道除了抗癌治療外，還有著病人的腫瘤蕈狀傷口照護問題是需要我去重視的。
護理部8A(血液腫瘤科)病房小組長吳玉琳協助腫瘤蕈狀傷口病人清理傷口並換上人工皮敷料(此病人非新聞稿案例)
吳玉琳指出，腫瘤蕈狀傷口照護的茁壯與精進，是照護團隊的一步一腳印，從發展腫瘤蕈狀傷口照護評估表、安排課室教學、運用心智圖繪製及腫瘤蕈狀傷口桌遊活動，提升護理師腫瘤蕈狀傷口的知識，創意發展擬真腫瘤蕈狀傷口模具，模擬出腫瘤傷口特性，包含出血、疼痛、滲液與惡臭特性。透過實際操作，提升了護理師照護腫瘤蕈狀傷口技能，亦減輕護理師面對腫瘤蕈狀傷口的心理壓力及衝擊。擁抱熱忱的在腫瘤蕈狀傷口照護教學努力下，所發展腫瘤蕈狀傷口教案，很幸運地得到院內教案競賽金獎殊榮，同時也將此照護成果投稿專業學會並獲得肯定。
護理部8A(血液腫瘤科)病房小組長吳玉琳協助腫瘤蕈狀傷口病人清理傷口並換上人工皮敷料(此病人非新聞稿案例)
吳玉琳表示，好的照護，是需要與病人與家屬的攜手合作的。經由護理師用心教導照護技巧、出院時完善的出院準備與追蹤電訪、更發展LINE群組「一隅有花」，適時了解並協助病人家屬照護蕈狀傷口，不讓病人和家屬回到社區時須獨自面對棘手複雜的傷口問題，讓醫療團隊真正成為病人及家屬堅強可靠的後盾。
護理部8A(血液腫瘤科)病房小組長吳玉琳整理護理工作車
奇美醫療財團法人奇美醫院一向以病人為中心，適時提供各種照護與心理支持，我們也會不斷的想盡辦法讓病人過得更好，這也是我們與病人共同的期待。
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