一位年輕肝癌末期病人之整體性護理經驗

Nursing Experience Involving Providing Holistic Nursing Care to a Young Patient with Terminal Stage of Hepatoma

鄭沛綾(Pei-Ling Cheng) ； 林玉菜(Yu-Tsai Lin) ； 陳芝文(Chih-Wen Chen)

《榮總護理》 34卷2期 (2017/06) Pp. 207-214

https://doi.org/10.6142/VGHN.34.2.207

摘要

本篇個案報告是描述一位26歲年輕女性肝癌末期的病人，除需調適癌症帶來的生理不適外，還須面對即將走到生命盡頭與家人生死分離的不捨與幼兒之安置。個案護理期間為2015年11月14日至2015年11月30日，筆者以會談、觀察、身體評估等技巧收集資料，藉由Gordon十一項健康型態功能進行評估，確立個案有一、體液容積過量；二、身體心像紊亂；三、預期性哀傷等健康問題。在護理過程中，筆者主動關懷個案及持續性照護，與病家建立良好護病關係，運用個別性護理措施解決個案的生理問題，採低鈉限水飲食及配合利尿劑以改善腹水及周邊水腫。心理靈性方面，個案自知生命期限將至，內心十分恐懼，且家屬難以承受生死分離之痛，團隊成員自入院後協同家屬著手收集及製作影音紀念專輯，供家屬及女兒長大後思念追悼母親，運用哀傷輔導協助個案面對死亡，與家人溝通，協調破除年輕人不可在家往生的傳統文化迷失，讓個案順利返家，與家人共享餘生之天倫樂，藉由整體性、個別性之照護措施，為生死兩相安之善終留下圓滿之見證。期望藉由本文之護理經驗，提供臨床同仁日後照護此類個案之參考。

關鍵字

年輕女性 ； 肝癌末期 ； 預期性哀傷

並列摘要

This article describes the nursing experience of caring for a 26-year-old female patient at the terminal stage of hepatoma. The patient not only had to adjust to the physiological discomfort but also had to cope with the end of life and separation from her family. The patient was nursed from November 14 to November 30, 2015. Data were collected by observation, interview, and physical assessment. Gordon's 11 Functional Health Patterns were used for evaluation, and the patient was found to have problems of fluid volume excess, body image disturbance, and anticipatory grief. While nursing the patient, the author provided initiative care and continuing nursing care to establish a good relationship with her and her family. Individualized nursing measures were used to solve the patient's physical problems. Low-sodium diets, fluid restriction, and diuretics were applied to improve ascites and edema. Regarding the psychological and spiritual aspects of care, the patient's fear of death, pain of separation from her family, and sorrow regarding her daughter were soothed in the process of making video and audio materials following hospitalization. The author also communicated with family members to overcome a cultural superstition that young people cannot die at home. The patient was then discharged and returned home. For the patient and the family, complete and continuing care was provided. This nursing experience may serve as a reference for people who care for terminally ill patients.

並列關鍵字

young female ； terminal stage ； hepatoma ； anticipatory grief

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