照護一位老年患肺部腫瘤個案藉由中醫整體觀協助其帶癌生存之護理經驗

Applying traditional Chinese medicine of holism model to nursing care for an octogenarians patient to peaceful coexistence and survival with lung cancer

許淑芬(Shu-Fen Hsu) ； 謝美雪(Mei-Hsueh Hsieh)

《中西醫結合護理雜誌》 3期 (2016/06) Pp. 72-87

https://doi.org/10.6211/TTCMNA.NO3-2016-07

摘要

本文旨在分享運用中醫整體觀照護一位老年肺部患腫瘤個案，面對醫療處置過程產生的不信任感、疾病對健康侵襲的機體症狀困擾及感受生命籠罩在罹癌的威脅，影響生活品質之護理經驗。護理期間自2013 年6 月6日至2014 年10 月28 日，筆者依據中醫整體觀念模式，並藉由四診、觀察及會談收集資料，評估個案產生的困擾問題：「活動無耐力」、「低自尊：情境性」、「調適障礙」、「營養狀況改變：少於身體需要」及「睡眠型態紊亂」。照護期間運用中醫整體觀“法於陰陽，和以術數，食飲有節，起居有常，不妄作勞”為具體法則；辨證施護擬定措施，協助個案在生命過程中的年歲能1)樂～情緒穩靜；2)動～動息自寧；3)吃～飲食知味；4)排～便尿調排；5)睡～體氣和平，使機體得以順應自然生活以降低症狀困擾程度，能夠及維持信念建立“腫瘤是一種慢性疾病”的共識漸接受罹病的事實，提升生活獨立性及品質而「帶癌生存」頤養到天年；嘉許家庭成員對個案的關懷及支持，使個案能得到持續性照顧直至終老，希冀以此中醫整體觀護理照護經驗提供相關護理人員日後照護之參考。

關鍵字

中醫 ； 整體觀 ； 肺部腫瘤 ； 症狀困擾 ； 帶癌生存 ； 辨證施護

並列摘要

This article describes the experience of the author in providing nursing care to an octogenarians patient with lung cancer who produced a feeling of insecurity because of the undergoing medical procedures. After the invasion of the disease symptoms of the health problems, and feeling fatally threatened by the cancer, the patient was unable to care for herself, and the quality of her life had been affected. The period of the care ran from June 6th 2013 to October 28th, 2014. The author used the Traditional Chinese Medicine of holistic model to collect information via correlation of all four examinations(四診合參), observation, and interviews. Five major nursing problems were identified in this case: activity intolerance, self-esteem-situational low, adjustment disorder, nutrition altered-less than body requirements, and sleep pattern disturbance. Based on these problems, the author constructed an syndrome differentiation and individualized care plan that can be adapted to daily life as follows: obeying the law of yin-yang, adopting variety of methods of health preservation, regulating diet, regular daily activities and never exerting too much. Assistance cases during the years of residual life. It endow encourage: 1) sentiment serene, 2) the comfortable movement, 3) delicious with food, 4) excretory function regulation, 5) reconcile with yin(陰)and yang(陽)of the physiological function. Human conform environment from regular daily activities with reduce of symptom distress, it is consensus for patient enabling and maintaining belief that ＂carcinoma is a kind of chronic disease＂ to accept things with cancer facts. Improve the self-care ability and enhance the quality with peacefully coexistence of the body and cancer and the long term survival with cancer. Commend the family for their care and support to the patient so that the patient would be taken good care of until her death. This paper that provides applying traditional Chinese medicine of holism model may serve as a reference for nursing care patient to peacefully coexistence and survival with cancer.

並列關鍵字

Traditional Chinese Medicine ； holism ； lung cancer ； symptom distress ； syndrome differentiation and nursing ； peaceful coexistence with cancer