照顧一位胃癌末期病人之護理經驗

Nursing Experience from Caring for a Terminal Gastric Cancer Patient

許佩誼(Pei-Yi Hsu) ； 洪麗琴(Lin-Zin Hung)

《領導護理》 21卷2期 (2020/06) Pp. 74-85

https://doi.org/10.29494/LN.202006_21(2).0007

摘要

本文為描述照護一位胃癌末期病人，面對疾病末期症狀困擾的身、心、靈衝擊之經驗，照護期間為2016年10月27至11月16日，藉由身體評估、理學檢查、觀察、會談、病歷查閱等方式收集資料，並運用Gordon十一項健康功能評估，確立病人有舒適情況改變、照顧者角色緊張和疲憊等健康問題。藉由症狀控制、營養支持，緩解其生理不適；應用跨團隊的介入，結合安寧緩和療護的照顧理念，以傾聽、陪伴和關懷態度，同理病人需承受疾病末期之症狀困擾與痛苦，給予情緒支持及撫慰，並協助病人家屬居家靜脈營養照顧及善終準備。照顧過程深感對末期病人提供人工營養及水分，是否利大於弊之倫理困境，持續與病人及家屬溝通，以提供符合其最大利益之照顧。建議日後照顧此類病人，能依病情進展，與醫療團隊、病人及家屬共同討論醫療介入之必要性，以提供病人最適切之照顧。

關鍵字

末期胃癌 ； 靜脈營養 ； 照顧者角色緊張

並列摘要

This article describes a caring experience of terminal gastric cancer patient who underwent physical, mental, and spiritual shocks facing terminal symptoms. Data collected from physical examinations, observation, discussions, and medical records inspection during the period of care from October 27 to November 16, 2016. ＂Gordon's Eleven Health Function Assessments＂ was applied to identify nursing problems such as comfort alteration, caregiver role strain, and fatigue. Nursing care includes relieving patient's physical discomfort through symptom control and intravenous nutrition support; apply cross-team intervention, combined with the care concept of tranquility and care, with listening, companionship and caring attitude. Empathy shown to patient who requires enduring the symptoms and pain of the final stage of the disease, and emotional support with soothe given to assist the patient's family to apply intravenous nutrition and the final preparation. The caring process made the author feels strongly about the ethical dilemma when providing artificial nutrition and water to the patient at the terminal stage, whether the benefits outweigh the disadvantages, and continues communication with the patients and their families to provide care in their best interest is the key to a successful care.

並列關鍵字

terminal gastric cancer ； intravenous nutrition ； caregiver role strain

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