照顧一位伊汶氏肉瘤癌末青少年之護理經驗

本文主旨在描述一位罹患伊汶氏肉瘤的單親癌末青少年在面臨疼痛的症狀困擾、生命末期的衝擊及家庭支持系統不足的照護經驗。護理期間為2020年3月11日至3月22日，筆者以生理、心理、社會及靈性之整體評估為架構，藉由實際參與照護過程進行身體評估、觀察、會談、傾聽及查閱病歷等方式收集相關資料，歸納分析個案的健康問題有疼痛、無望感及家庭因應能力失調。照護過程中運用團隊資源合作，主動關懷、同理、傾聽陪伴及給予心理支持，與個案及家屬建立良好的護病信任關係。於生理困擾方面，提供個案藥物及非藥物的緩解疼痛措施，在心理層面，當個案焦慮及抑鬱時，協助並引導說出心中感受及抒發壓力及情緒，對於家庭成員間的付出，秉持著感恩、感念及感謝之意，讓個案及家屬能正向面對癌末的症狀及病情進展，也讓彼此皆可獲得身心靈安適。然雙親對於個案的臨終照護意見分歧，筆者無法在護理期間與個案和雙親深入探討死亡議題及提供相關的協助，但經由團隊整合性的照護，於個案疼痛獲得控制後完成返家心願，期盼經由本文的分享可提供兒童血液腫瘤科護理人員在照護癌末青少年之參考依據，藉此提升臨終青少年優質及完善的照護品質。

關鍵字

伊汶氏肉瘤；癌症末期；青少年

並列摘要

The case report highlighted on the care experience of a terminal teenager from single parent family with Ewing's sarcoma and suffering from painful symptoms, end-of-life shocks and insufficient family support systems. The nursing period was from March 11 to March 22, 2020, author used the overall physical, psychological, social and spiritual assessment as a framework, through participating in nursing practice of physical assessment, observation, interview, listening, and review of medical records, etc. to collect relevant information, summarize and analyze the health problems of patient, such as pain, hopelessness and family coping ability imbalance. During care process, we used team resources cooperation giving active care, empathize, listen, companions and psychological support to maintain a good care and trust relationship with patient and family members. In terms of physical injury, we provided both medication and non-drug therapy to relief pain; in psychologically, when patient was filled with anxious or depressed, we helped and guide him to express feelings to release pressure and emotions, and upholding gratitude, grateful, and appreciate to family contribution. So that, the patient and family members can be more comfortable to face the symptoms of terminal cancer and progress of the disease; and each other gained the physical and spiritual well-being. Due to the parents had different opinions on the end-of-life care of patient, author cannot discuss the death toll in-deep with the patient and parents to provide relevant assistance during the nursing period. However, it was necessary to use the integrated care of team to complete the wish of return home after pain controlled. We hope this experience can provide a reference for the nursing staff in the Department of Childhood Hematology and Oncology in caring teenagers with terminal of cancer to give them a high and complete quality of care at the end of life.

並列關鍵字

Ewing's sarcoma ； Terminal Stage ； Adolescent

參考文獻

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