以安寧療護理念照護一位肝癌末期病人之經驗

本文乃探討一位年輕肝癌末期女性病人之安寧療護經驗。筆者於2010年10月9日至18日在安寧病房中，以Gordon十一項功能性健康模式進行整體性評估，藉由直接照護、觀察、會談及團隊會議探討等方式收集主、客觀資料，確認護理問題有：肝臟腫瘤引起的疼痛與腹水（體液容積過量）、面臨死亡分離引起的預期性哀傷及靈性困擾等健康問題。護理過程中，生理方面的疼痛除了止痛劑之外，藉由輔助療法以精油按摩緩解；腹水改善採低鈉限水飲食，配合利尿劑、高蛋白之給予；心理靈性方面，因為病人被診斷肝癌後，自知所剩時日不多，其內心之焦慮與惶恐非常人可體會，因此，筆者依尋病人之迫切需求，以完成其「心願」為首要目標，最後終於讓病人與案前夫臨終前得以善解；由於病人診斷至往生時間相當短暫，案母難以承受此失落之痛，故自病人入院開始醫療團隊著手策劃，製作了相關影音資料，來化解案母日後思女之愁；並藉宗教師之參與，化悲傷為祝福，讓病人於充滿愛與幸福中無憾的往生，為生死兩相安的善終提供了整體性、個別性與連續性的照顧。建議後續仍須不斷予遺族關懷及輔導。期望藉此護理經驗能提供臨床照護之參考。

關鍵字

肝癌末期；安寧療護；預期性哀傷；靈性困擾

並列摘要

This study involves the nursing experience of a young woman with terminal hepatic cancer. The author assessed the subject with Gordon's 11 functional health assessment tool, and collected the data through observation, conversation, and team meeting. The duration of nursing care was from October 9 to 18, 2010. The patient's problem included pain caused by abdominal tumor, fluid volume excess, anticipatory grief, and spiritual distress. For the physiologic aspects, we applied oil massage by aromatherapy to relief cancer pain, and provided diuretics, high-protein and low sodium diet, and water restriction to reduce ascites. For the psychological and spiritual aspects, we accomplished the patient's desire to reconcile with her ex-husband before death. Moreover, the medical team had planned to do the video recording of the subject to relief the mother's pain from losing her daughter. We also encouraged the family to seek more mental support from the chaplain who offered grief care. Finally, the patient had passed away with full of love and no regret. The nursing process applied hospice care of holistic, individualized, and continuity. We hope the bereavement counseling of the family will continue and this nursing experience will provide a reference for caring terminally ill patients.

並列關鍵字

terminal hepatic cancer ； palliative care ； anticipatory grief ； spiritual distress

國際替代計量

以安寧療護理念照護一位肝癌末期病人之經驗

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