- 期刊
照顧一位惡性腫瘤合併肺部轉移末期病童之護理經驗
End-of-life Care Experience for a Pediatric Patient with Malignant Sarcoma and Lung Metastasis
摘要
本文描述一位惡性腫瘤青春期兒童合併肺部轉移，面對疾病末期帶來的身、心靈衝擊及調適的護理經驗。於2020/5/14至5/25日擔任個案之主護護理師，護理期間藉由身體評估、傾聽、觀察、會談及病歷查閱等方式，依生理、心理、社會、靈性四大層面進行整體性評估，歸納出個案有低效性呼吸型態、疼痛、面對疾命末期之焦慮不安等健康問題。透過建立信任關係、澄清、討論及提供明確資訊，尊重個案參與自己醫療決定的空間；予嗎啡及個別性的護理措施，減緩癌症末期症狀引起的呼吸困難、疼痛；利用跨團隊合作，藉個案喜愛的遊戲及手作活動轉移對不適症狀的注意力，以不直接談論死亡的方式，給予個案空間自我統整，協助提升表達自我意願，增加家庭成員間有效溝通，使家庭能共同準備面對即將到來的離別。藉由此照護經驗，期能於照護相似病人時的參考與運用。建議可藉教育課程提升臨床醫護人員於照護末期病人的溝通與知識能力，以及其他可轉介之相關專業領域的認識，於照護末期兒童時能提供其家庭更加完善的護理。
並列摘要
This article focuses on sharing the nursing experience regarding a pre-teen patient who suffer from malignant sarcoma and lung metastasis at his end-of-life stage. From May 14, 2020 to May 25, 2015, client's data were collected through direct care, physical assessments, interviews, and by medical records. The client's health issues included inefficient breathing patterns, pain, and anxiety about being at terminal stage of illness. Nursing care was first targeted on adequate pain control, dyspnea alleviation. Then using a recreational therapy technique to shift client's attention away from discomfort. The team members avoid talking about dying prematurely allowing the client to express his own thoughts and fears and increase effective communication between family members. Using a multidisciplinary approach, we worked with the client and family to successfully face the impending death together. How to cooperate with multidisciplinary teams and the concept of hospice care should be included in pediatric in-service programs to help nurses in improving their care quality.