一位結腸癌末期病人撤除維生醫療死亡之護理經驗

Care Experience of a Terminal Colorectal Cancer Patient after Withdrawal of Life-Sustaining Treatment

陳宜吟(Yi-Yin Chen) ； 陳宥蓁(Yu-Chen Chen)

《澄清醫護管理雜誌》 15卷2期 (2019/04) Pp. 57-65

摘要

本文旨在探討一位結腸癌末期高齡病人，選擇撤除維生醫療達自然死亡之護理經驗。筆者為醫院安寧共照護理師，照護期間自2017年5月23日至2017年6月3日，運用Gordon十一項功能性健康型態評估，經由直接照護、身體評估、會談及病歷查詢等方式收集資料，確立病人有「舒適障礙」、家屬有「焦慮」及「預期性哀傷」等三項護理問題。護理過程中藉由協助止痛藥調整、舒適擺位、熱敷、芳香精油與穴道按摩等療法改善病人不適；與原團隊合作模式下，召開家庭會議提供家屬撤除維生醫療之前、中、後完整照護的資訊，達成醫療決策共識，協助病人移除維生醫療並獲得適切的後續照護；指導家屬嘗試腹式深呼吸運動、建立睡前放鬆儀式緩解家屬焦慮不安情緒，並運用主動陪伴與傾聽，引導家屬表達內心感受、討論病人受苦的意義、完成四道人生與後事準備等方式，幫助家屬渡過哀傷歷程；社工師陪伴引導家屬表達壓力處理方式與強化支持系統，協助家屬增進面臨困難決策與死亡壓力的因應能力。在全團隊共同照護努力下，使病人能有尊嚴地安然善終，家屬安適的陪伴其人生最後旅程，達到生死兩相安，期望藉此護理經驗分享，做為臨床護理人員照護之參考。

關鍵字

結腸癌 ； 臨終照護 ； 撤除維生醫療

並列摘要

The aim of this paper was to discuss the care experience of an elderly patient with terminal colon cancer, who chose to withdraw life-sustaining treatment and die naturally. The author is a shared care nurse in a hospice who took care of the patient from May 23 to June 3, 2017. Gordon's 11 Functional Health Patterns was used for evaluation and information was collected through direct care, physical assessment, conversations, and medical records. The patient was confirmed to have impaired comfort, and his family members experienced anxiety and anticipatory grief. During care, treatments like readjusting pain-killers, lying comfortably, hot compress, essential oil, and acupoint massage were administered to alleviate the patient's discomfort. Collaboration with the patient's original medical team and family meeting were used to provide family members with information on care before, during, and after withdrawal of the life-sustaining treatment, and consensus on a medical decision was reached to assist the patient in withdrawing the life-sustaining treatment and obtaining subsequent appropriate care. The family members were guided on abdominal deep breathing exercises and relaxation methods before sleeping to alleviate their feelings of anxiety and uneasiness. In addition, active companionship and listening was used to guide family members to express their feelings; discuss the meaning of the patient's suffering; complete the expression of love, apology, gratitude, and farewell; and funeral preparations, and assisting the family members in transitioning through the grief process. The social worker guided the family members in stress management techniques and strengthening support systems and assisted them in improving their coping ability in the face of difficult decisions and the stress of death. With the joint care efforts of the entire team, the patient was allowed to die with dignity and peace, and the family members comfortably accompanied the patient in his last stage of life. The author hoped that this nursing experience can be used as a reference for care by clinical nursing staff.

並列關鍵字

Colon cancer ； Terminally-ill patient care ； Withdrawing life-sustaining treatment