Chapter 25: Wound management
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Principles of care
Psychosocial support for patients who present with a fungating tumour
There are many goals in caring for a patient with a fungating tumour; psychological support features heavily. In this, one of the main aspects is controlling symptoms, which in turn may improve the patient's quality of life and psychosocial well‐being.
There are many challenges to a patient presenting with a tumour of this type and an empathetic nurse–patient relationship is paramount in providing support. Patients often feel socially rejected and distressed, so allowing expression of fears and concerns is important. Studies have shown that living with a fungating wound causes distress, thus inducing feelings of worthlessness, embarrassment, fear of the stigma associated with cancer and a constant reminder of its presence (Piggin and Jones [112]).
For many patients there is a loss of sense of self when they are living with a tumour and they may feel unable to face the world on a day to day basis. Many female patients have highlighted a loss of femininity. The inability to wear a bra because of the tumour and dressing affects the ability to choose clothes of a feminine nature (Reynolds and Gethin [115]). Sensitivity, understanding and emotional intelligence shown by the nurse can greatly improve the patient's feelings and self‐image. Knowing that someone understands what they are going through can often help.
Providing holistic and supportive care can often give the patient the opportunity to live as full a life as possible, within the limitations of their disease.
Choice of an appropriate dressing can be challenging for a nurse when caring for a patient presenting with a fungating tumour, yet this can affect how the patient reflects upon themselves. A nurse needs confidence in her communication skills and ability when being involved in a patient's care. Managing the odour can be part of the task, as this can affect the patient in many ways. Social relationship was found to have suffered as a direct result of malodour (Gibson and Green [50]). This breakdown in a patient's ability to be confident socially may also have financial implications for them or their families.
The continuous improvement of nursing knowledge is important as it reflects in a nurse's evidence‐based practice. A passion for this area of nursing is not enough; there is a professional, personal and collective responsibility to continue to enhance knowledge and understanding in light of new strategies as well as applying proven strategies to patient care (Benbow [16]).
The nurse may also be involved in giving support to the family or loved ones of a patient presenting with a fungating tumour. This often involves assessing if there are any gaps in care and assessing how he or she can offer practical assistance or help. Caring for a loved one with a malignant fungating tumour causes psychological distress (Probst et al. [114]).
Support offered by the nurse to the patient and family can help them on their constant course of adjustment that living with and learning how to manage a fungating tumour brings.
