照護一位癌末腦轉移個案抉擇衝突之加護經驗

Caring Experience of a Terminal Patient with Brain Metastases for Dilemma Dispute in Intensive Care Unit

顏毓嫻(Yu-Hsien Yan)

《領導護理》 20卷3期 (2019/09) Pp. 65-78

https://doi.org/10.29494/LN.201909_20(3).0006

摘要

本文為照護一位淋巴癌腦轉移之個案，因突然的意識改變及呼吸窘迫而入住加護病房接受照護，個案及家人對於癌末疾病的進展難以接受而採積極搶救的態度，在面臨是否要行氣切、簽立拒絕實行心肺復甦術等抉擇有所困境。於照護期間2015年4月5日－2015年4月16日，透過病歷查閱、護理照護、家人的訪談、個案的反應觀察，以身、心、靈、社會層面評估確立個案有：呼吸道清除功能失效、抉擇衝突、恐懼之健康問題。照護過程當中，協助個案維持呼吸道暢通及減少呼吸困難的不適；與個案及家屬建立信任感，以多次對談了解家屬想法，透過說明、澄清、同理的方式，協助個案及家人抉擇是否行氣切並簽立拒絕實行心肺復甦術；再者，以明確、簡短的話語予個案殘存知覺刺激，減少個案視覺喪失所造成的恐懼，並透過靈性護理協助個案及家人接受並面對死亡恐懼，繼而為死亡作準備，使個案獲得較為舒適的生命末期。希望藉此個案，分享於加護病房當中對於癌症腦轉移病患之身心靈照護，及病患及其家庭可能面臨的抉擇議題。

關鍵字

腦轉移 ； 抉擇衝突 ； 恐懼

並列摘要

This report is based from a nursing experience of caring a lymphoma patient with brain metastases. She lost her consciousness and experienced respiratory failure suddenly. The patient and her family had dilemma in DNR or tracheostomy, and they still prefer to take chemotherapy treatment. During the period of April 5 to 16 in 2013, three nursing problems were identified from caring patient, inspection, consulting with her family, and inspecting medical records. From physical, psychological, and social levels, the nursing problems were confirmed to include ineffective airway clearance, decisional conflict, and fear. During the nursing period, the author assists the patient and her family to make decision by explaining, clarifying and empathizing methods. In order to assist the patient reducing the fear of losing sensory perception and terminal illness, utilizing the psychological nursing method was conducted to soothe patient for a comfortable period towards her end of life. This case was shared for the purpose of a reference when caring for similar case in the future in terms of physical, psychological, and spiritual caring level. As well as the dilemma that patients and their families can possibly encounter.

並列關鍵字

brain metastases ； decisional conflict ； fear

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