照顧一位肺癌末期併發骨轉移病人之護理經驗

本文乃探討一位肺癌末期併發骨轉移之個案，在病況持續惡化，面臨疾病造成的身體不適、哀傷等問題。護理期間自2016年12月12日至12月22日，藉由直接照護、會談及觀察家庭互動等方式，並運用整體性評估，收集生、心、社會與靈性層面等資料，歸納出個案有低效性呼吸型態、慢性疼痛及有預期性哀傷等健康問題。經由主動關懷、陪伴建立信任之護病關係，教導腹式及噘嘴呼吸，運用疼痛十分量表評估疼痛指數，鼓勵其表達對疼痛的感受，並提供獨特性的護理措施，精油按摩及音樂轉移注意力來減輕疼痛；藉由會談技巧鼓勵個案與家屬說出內心真實感受，及面對即將死亡的事實，引導家屬敘說心中對個案的感謝及死亡的準備。末期臨終需照顧陪伴的家屬及其整個家庭成員，因此，建議護理人員亦需多參與有關哀傷輔導等相關課程，及早進行哀傷評估及輔導，以提升末期病人及家屬之照護品質。期望藉此護理經驗的分享，作為照護類似個案的參考。

關鍵字

肺癌末期；慢性疼痛；預期性哀傷

並列摘要

This article described the nursing experience of caring a terminal lung cancer patient with bone metastases. The patient's condition exacerbated with illness and faced with problems of physical discomfort and grief. The period of nursing care was from December 12 to December 22, 2016. Comprehensive biopsychosocial and spiritual information were collected through direct patient care, interview, and family interaction, and observation. Health problems included ineffective breathing pattern, chronic pain, and anticipatory grief. Nursing interventions included providing the patient with active caring and accompany to establish reliable nurse-patient relationship, instructing abdominal and purse-lip breathing, applying the pain visual analog scale to assess pain level, encouraging the patient to express pain feeling, providing individualized nursing interventions such as aroma massage and music for distracting attention and pain, interviewing the patient and family members to speak out the real feeling about facing the impending death, guiding family members to talk about their appreciation to the patient and preparation for death. This paper suggests that the nursing staff participate in grief counseling related courses and conduct early grief assessment and counseling to enhance the quality of care on terminally-illed patients and their family members.