照護一位罹患骨髓發育不良症候群瀕死患者之護理經驗

Caring of a Patient Dying of Myelodysplastic Syndrome

林珈而(Chia-Erh Lin) ； 張秋純(Chiu-Chun Chang) ； 游顯妹(Hsien-Mei Yu)

《中山醫學雜誌》 19卷2期 (2008/12) Pp. 221-233

https://doi.org/10.30096/CSMJ.200812.0008

摘要

本文主要探討一位骨髓發育不良症候群之病患與其家庭在面臨疾病所引發的不適與面臨死亡之護理經驗。護理期間由2006年6月24日至7月2日，筆者藉由直接照護、傾聽、關懷及會談技巧，與個案和家屬建立良好的護病關係，並以Gorden十一項功能性健康型態進行資料收集與分析，發現個案的護理問題有氣體交換障礙、睡眠型態紊亂、保護能力改變、預期性哀傷（家屬），針對這些問題提供個案經由輸血治療提升血液攜氧能力以維持適當的氣體交換，協助改善睡眠環境以增進睡眠品質，採用適當隔離技巧、集中式護理及注意安全使個案免於受傷等護理措施，以減輕個案生理上的不適，並提供家屬面臨個案可能死亡之哀傷照護與諮詢，運用同理心關懷與支持，讓雙方能做好相互道別的準備，最後使家屬平靜且無遺憾的面對個案死亡過程。

關鍵字

骨髓發育不良症候群 ； 瀕死 ； 護理

並列摘要

This article reports a nursing experience caring for a patient with myelodysplastic syndrome and helping the caregiver face the challenges of end-of-life care. During the nursing period which lasted from 2006/6/24 to 2006/7/2, direct care, listening, showing concern, and interviewing the patient and care-givers were used in care for this patient. Through these skills, a good relationship was built. We used Gordon 11-item functional health scale to collect data for our analysis. The major problems the patient encountered were distressed respiratory function with impaired gas-exchange, sleep disturbance, anticipatory grieving, and altered ability protect oneself. In order to solve these problems and offer the proper end-of-life support to the patient and the care-givers, blood transfusion was performed to increase oxygen supply and gas exchange, the room environment was improved for better sleep quality, appropriate individualized nursing care was adopted particularly focusing on more intense and compassionate mental and physical care for this patient. Through these efforts, the patient and care-giver both received better quality end-of-life support. Finally, the patient died peacefully while the family faced it calmly without regret.

並列關鍵字

Myelodysplastic Syndrome ； MDS ； dying ； nursing