- 期刊
照顧一位腦癌末期併發頸椎轉移選擇撤除維生醫療病人之加護經驗
Intensive Care Experience of a Terminal Brain Cancer Patient with Cervical Metastasis Who Decided to Remove Life Support Treatment
摘要
本文描述一位45歲罹患腦癌末期併發頸椎轉移選擇撤除維生醫療病人之加護經驗。護理期間2017年6月19日至7月10日，藉由實際照護、身體評估、查閱病歷及會談方式蒐集相關資料，進行生理、心理、社會及靈性層面之整體性評估，評估病人有呼吸道清除功能失效、自我照顧功能缺失、死亡焦慮、預期性哀傷之健康問題。護理過程中主動關懷與病人建立良好的護病關係，提供個別性護理活動，採跨領域團隊進行合作討論，降低因呼吸道清除功能失效及自我照顧功能缺失可能導致的呼吸道阻塞及肢體攣縮，透過陪伴、傾聽、同理、會談技巧、生命回顧等方式，協助病人及其家人面對死亡，引導病人說出內心真實感受，降低死亡焦慮，當疾病進展到末期，藉由醫療團隊及家庭討論會，讓家屬尊重病人選擇預立安寧緩和醫療暨維生醫療抉擇意願書，並協助完成病人心願，透過宗教信仰及佛教師父開示，引導家屬面對病人即將死亡的哀傷，在照護過程中達到讓病人安心，家屬無憾的全人、全家、全隊及全程的照護。
並列摘要
In this paper, we describe the intensive care experience of a 45-year-old male patient with brain cancer and cervical spine metastasis who decided to withdraw life support treatment in the terminal stage of the disease. The nursing period was from June 19 to July 10, 2017. A holistic assessment of physical, psychological, social, and spiritual aspects was made through physical observation, interviews, and physical assessment methods. Health issues were established as follows: (1) ineffective airway clearance, which was related to the involvement of respiratory muscles causing poor efficacy of cough; (2) loss of self-care functions, which was related to brain cancer with cervical metastasis leading to limb weakness, which hindered performance in daily tasks; (3) fear of death, which was related to the stress the patient was experiencing because of imminent death and separation from family members; and (4) anticipatory grief, which was because of family members realizing the limited life span of the patient. The nursing team, provided active care to establish a good relationship with the patient and individual care activities. Multidiscipline teamwork was conducted to reduce the possibility of airway obstruction resulting from the failure of respiratory clearing and contracture of limbs because of the loss of self-care functions. By providing company, listening with empathy, striking a conversation, and allowing the patient to review his life, we assisted the patient and his family members to prepare for death, express their real feelings, and relieve the anxiety of imminent death. When the disease progressed to the end of life, the medical team and family members met for a discussion, and the patient agreed to sign consent on the removal of hospice and palliative care. The family members understood and respected the will of the patient. We fulfilled the patient's wishes and alleviated the grief of his family members by bolstering their morale through their religious beliefs and help from Buddhist masters. The medical team managed to provide holistic care to the patient and family members throughout the whole nursing course to allow the patient and family members to attain peace.