- 期刊
照護一位肺癌末期獨居長者之安寧居家療護善終之護理經驗
The Home-Based Hospice Pailliative Care Experience of an Elderly Patient with Terminal Lung Cancer Living Alone
摘要
本篇是一位90歲高齡獨居女性、肺癌末期併對側肺轉移，因期望在宅善終，採用安寧居家照護模式結合遠端科技照護之護理經驗。護理期間自2019年11月12日至11月28日，共6次居家訪視，每次實地居家訪視時間約50－90分鐘，每次訪視運用生理、心理、靈性及社會層面整體性評估，並經由觀察、會談、身體評估、電訪及手機視訊等方式收集資料，確立個案有呼吸困難、潛在危險性傷害、心靈困擾之健康問題。故提供製氧機、嗎啡類藥物減輕個案呼吸困難症狀，改善臨終呼吸喘及喉頭音；因個案獨居，故護理過程中協助連結社區長照資源、結合遠端科技運用通訊軟體與醫護端即時溝通處理症狀，減輕家屬照護壓力、降低獨居傷害風險。照護期間個案尋求在宅善終，故予陪伴傾聽，引導個案生命回顧，說出善終意願，並召開家庭會議，協助案家達成共識，透過即時通訊軟體及臨終症狀衛教準備，降低家屬焦慮及照護不確定感，讓個案享有最大自主權，有尊嚴的離世，圓滿在宅善終心願。
並列摘要
This article presents a 90-year-old female terminal lung cancer patient with contralateral metastases. She experienced peaceful at-home hospice care combined with remote care during the nursing care from November 12 to November 28, 2019. There were six home visits, each for about 50-90 minutes. The assessment tool of the hospice care was employed to evaluate the patient's physiological, psychological, spiritual, and social status. Data was collected through observations, face-to-face interviews, physical assessments, telephone interviews, and video chat. The patient's problems identified were dyspnea, potential risk of injury, and spiritual distress. Therefore, the oxygen generator and morphine drugs were provided to reduce dyspnea and stridor. As the patient was living alone, there were many tasks to be done, including connecting the community's long-term care resources, combining home and remote care, communication software for immediate assistance to relieve symptoms during the nursing process, and improved family caregiving burden. As the patient was expecting to die at home, there was a need for companions to listen to her and guide her. We held family meetings to discuss end-of-life management to reduce anxieties and sense of uncertainties. There was a need for respect for the autonomy of the patient to help fulfill her wish of living in the house and leaving the world with dignity.