運用Swanson關懷理論於一位癌末病人及主要照顧者之護理經驗

A Nursing Experience of Applying the Swanson's Caring Theory on a Terminal Cancer Patient and the Caregiver

曾毓閔(Yu-Min Tseng) ； 林仲祺(Chung-Chi Lin) ； 詹淑惠(Shu-Hui Chan)

《長庚護理》 28卷4期 (2017/12) Pp. 654-664

https://doi.org/10.3966/102673012017122804007

摘要

本篇個案報告係運用Swanson關懷理論於一位癌末病人及主要照顧者的照護，護理期間為2014年7月25日至8月3日，藉由直接照護、觀察、會談等方式收集資料，依生理、心理、社會與靈性四大層面評估發現個案健康問題為疼痛及無望感，而主要照顧者則有照顧者角色緊張及預期性哀傷。護理過程運用Swanson關懷理論，經由「了解」、「在旁陪伴」鼓勵個案及照顧者表達此次病況的影響及內心感受，運用「為他做某些事」、「使他能夠」的過程，提供精油按摩、熱敷、音樂治療等疼痛控制方式緩解個案不適，並提供護理指導及放鬆技巧解決照護疑慮及緩解緊張焦慮，並和子女利用照片及寫信進行生命回顧，肯定個案人生意義並說出對彼此的感謝，使個案及照顧者在最後能「維持信念」，以正向的態度共同面對生命末期的到來。期望透過此經驗分享，勉勵相關護理同仁多加運用關懷理論於臨床照護，並建議日後有照護類此病人之相關單位可定期舉辦案例討論會或關懷技巧運用課程，針對不同的個案討論不同的關懷照護計畫，以提升癌末病人及照顧者生心靈的照護品質。

關鍵字

Swanson關懷理論 ； 癌末病人 ； 主要照顧者

並列摘要

This article delineates a nursing experience of utilizing the Swanson's caring theory on a terminal cancer patient and the caregiver. The nursing period lasted from July 25th to August 3rd, 2014. The author collected and analyzed data on the patient's physiology, mental acuity, social nature, and spirituality through observation and communication. The author identified pain and hopeless due to lack of prognosis-control as the primary problems of this patient, and both caregiver role strain and anticipatory grieving contributed the suffering of caregiver. Utilizing the Swanson's caring theory, ＂knowing and being with＂ may encourage patient and caregiver to talk through their current difficulty situation and feeling. By ＂doing for and enabling＂, the author provided aromatherapy massage, hot fomentation, and music therapy for pain management. Besides, introduction of nursing guide and relaxing technique may alleviate caregiving difficulty and stress. Life review with family members through photo and letter writing can ＂sustain belief＂, generate and maintain a positive attitude at the moment of death. Patient focused on what he has accomplished in his life span and expressed immense gratitude to each other. The author wishes to share this nursing experience with all nurses to encourage clinical practice with caring theory. The author also suggests more case study and caring technique program may be beneficial in taking care of the similar patients in the future in term of palliative and spiritual care.

並列關鍵字

Swanson's Care Theory ； terminal cancer ； caregiver

參考文獻

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