- 期刊
照顧一位急性白血病病人復發後面臨生命末期之護理經驗
Nursing Experience with End-of-Life Care for a Patient with Relapsed Acute Myeloid Leukemia
摘要
本文係協助一位急性骨髓性白血病復發且化學治療效果不如預期之個案接受安寧緩和共同照護，陪伴其面對生命末期的照護經驗。護理期間為2019年5月24日至2019年8月14日，藉由觀察、會談、身體評估、病歷查閱等方式收集資料，以身體、心理、社會及靈性四層面做整體性評估，確立個案有呼吸困難、睡眠型態改變、預期性哀傷等健康問題。照護過程中透過主動探視陪伴，協助使用非侵入性正壓呼吸器、教導噘嘴腹式呼吸、運用芳香療法搭配按摩、減少夜間因調整呼吸器面罩而中斷睡眠，降低個案生理不適；透過醫療團隊說明診療計畫及多次關懷，漸進式地引導後事準備，並照會安寧共照護理師協助減緩其瀕死相關症狀之不適，透過四道人生，個案向親友表達其內心感受，最後完成其返家臨終之心願。建議臨床上可多舉辦安寧緩和照護之病友團體衛教，以提升病人及家屬對安寧緩和療護的接受度，以達全人照護及善終之目的。
並列摘要
This article describes the nursing experience of accompanying a patient with relapsed acute myeloid leukemia in her end-of-life term. The patient's treatment outcome was below expectation and indicated the need for hospice combined care. The data were collected by observation, interview, physical assessment, and medical record review from May 24 to August 14, 2019. The physical, psychological, social, and spiritual health issues included insufficient breathing pattern, a disturbed sleep pattern, and anticipatory grieving. Through frequent visits and by accompanying the patient, we provided instructions about using noninvasive positive pressure ventilation (NPPV), pursed-lip and diaphragmatic breathing, aromatherapy massage, and avoiding sleep interruption by adjusting the NPPV mask to relieve her discomfort. With the help of the hospice team, we provided combined care and help with preparing for the end of life. We recommended the patient about fulfilling the four principles of life and impending death, while gradually introducing the funeral arrangement. To improve the quality of holistic care and the acceptance of hospice care among the patient and the families, frequent group education of hospice combined care is recommended.