末期乳癌之安寧緩和照護：一個案報告

Hospice Palliative Care of Terminal Breast Cancer-A Case Report

施君穎(Chun-Ying Shih) ； 顧雅利(Ya-Lie Ku)

《安寧療護雜誌》 13卷2期 (2008/05) Pp. 226-238

https://doi.org/10.6537/TJHPC.2008.13(2).8

摘要

本文敘述一位接受安寧緩和療護的乳癌末期個案，於住院期間出現生理、心理、社會、靈性等問題之照護經驗。筆者透過台灣安寧緩和護理學會所制定之安寧療護患者評估單，對個案的身、心、靈、及社會等層面進行整體性及連續性評估，運用會談、觀察家庭互動、和身體評估等方法收集資料，確立個案因化學治療之副作用、癌症骨骼轉移、身體外觀改變及害怕面臨死亡，而出現噁心、疼痛、身體心像紊亂、死亡焦慮等健康問題。透過家庭會議及醫護團隊擬定護理計畫，提供個案身、心、靈個別化的照護，例如芳香、音樂、經穴按摩等療法來緩和個案的身體症狀，關懷、傾聽、同理、宗教師靈性引導、安排社工和志工的陪伴、以解決其身體心像和死亡焦慮問題，並運用生命回顧引導個案肯定生命意義，提昇其內在力量，以超越生死障礙，和順利地完成人生的最後階段，期許此篇個案報告提供護理人員面對癌末病患時，能以全人、全家、全程、全隊理念來提供其身、心、靈、及社會等方面照護之參考。

關鍵字

乳癌 ； 安寧緩和療護

並列摘要

This paper is to describe a terminal breast cancer case who has accepted the hospice palliative care and the care experiences of physical, psychological, social, and spiritual problems during hospitalization. The author used the assessment sheet developed by Taiwan Hospice Care Nursing Association to assess the case’s physical, psychological, social, and spiritual aspects comprehensively and continuously and collected data through conversation, observed family interaction, and physical assessment that identified nausea, pain, body image disturbances, death anxiety health problems due to the side effect of chemotherapy, cancer transferred into the bone, body appearance changed, and fear facing death. Through family meeting and medical/nursing team, a nursing plan was designed as providing the case's physical, psychological, and spiritual individualized care. For instances, aroma, music, acupoints massages therapies can release the case's physical symptoms, and caring, listening, empathy, priest mentor leading, arranged social and volunteer accompanied can solve body image and death anxiety problems. Additionally, life-review was applied into the case to affirm his life-meaning and promote his inner power to overcome the barriers of life and death, and complete the final stage of human beings successfully. It is expected that this case report can provide as a reference for nurses to care the physical, psychological, spiritual, and social aspects of the cancer terminal case in the way of whole men, whole family, whole process, and whole team.

並列關鍵字

breast cancer ； hospice palliative care