運用關懷理論於一位食道癌末期病人之護理經驗

Nursing Experience of Applying Watson's Caring Model to a Esophageal Cancer Patient at the Terminal Stage

邱惠金(Hui-Chin Chiu) ； 林美蓮(Mei-Lien Lin)

《腫瘤護理雜誌》 12卷2期 (2012/12) Pp. 89-100

https://doi.org/10.6880/TJON.201212_12(2).08

摘要

根據行政院衛生署統計資料顯示，2010年國人十大死因，癌症已連續二十九年高居榜首，當個案得知罹患癌症面臨死亡威脅時，將遭受身、心、靈各方面的痛苦與衝擊。本文是一位49歲男性食道癌末期個案的護理經驗。筆者於2011年4月13日至4月27日護理期間，藉由傾聽、觀察、會談、身體評估及查閱病歷作為整體性評估，發現主要健康問題有營養不均衡、疼痛、無望感及社會支持性不足問題。運用Watson關懷理論作為護理照顧原則，提供完整的營養照顧計畫、與醫療團隊討論用藥合適性，運用調整呼吸速率轉移對疼痛注意力，改善個案營養狀況並有效緩解疼痛，並藉由主動陪伴、積極關懷，鼓勵個案表達內心感受，協助個案調適負向低落的情緒，坦然面對疾病的發展，促使個案能在人性化的護理過程中，完成自己的意願達到善終目的。藉此個案護理經驗作為分享，提供臨床同仁日後照護此類個案之參考。

關鍵字

食道癌 ； 無望感 ； 關懷

並列摘要

Cancer has been the top leading cause of death for over 29 years in Taiwan. When a patient is diagnosed as cancer disease, and faces the threatening of death, he/she experiences physical, psychological and spiritual suffering and struggling. This case report shares the nursing experience for a 49-year-old esophageal cancer patient at the terminal stage. Data were collected through listening, observation, interview, physical examination, and chart review during the period between April 13 and April 27 in 2011. There were four primary health problems were identified during the nursing process including: nutrition, imbalanced; pain; hopelessness; and poor social support. Watson's caring model was used to provide the integral caring plans. The authors also discussed the appropriateness of medication with medical team, regulated the patient's respiration rates to transfer attention rfrom pain, improve the patient's nutrition intake, and alleviate his pain. In addition, the authors help the patient adjust depress mood, openly face the progress of the disease through accompanying, caring, and expressing his feelings. Under the humanistic care, the patient fulfill his willingness during life, and achieving the goal of good dying. This case report shares the experiences and knowledge in caring patients with esophageal cancer during terminal stage, and can be used as a reference for clinical nurses in the oncological units.

並列關鍵字

esophageal cancer ； hopelessness ； caring