運用生命回顧協助一位肺癌末期併腦部轉移病患及家屬之護理經驗

本文是透過跨團隊照護模式協助一位中年男性肺癌末期併腦轉移及家屬之護理經驗。病人因初次罹癌合併以腦轉移導致身體疲憊與日俱增之外，帶來龐大的心理衝擊，及家屬面對病患即將死亡，不知如何表達及抒發哀傷的情緒。筆者於護理期間2019年3月27日至2019年4月28日，運用Gordon十一項健康功能型態，藉由會談、觀察評估，確認主要健康問題：（一）、急性疼痛／與癌細胞腦部轉移有關；（二）、呼吸道清除功能失效／與肺部浸潤有關；（三）預期性哀傷／與家屬意識到病人即將離世有關。照護期間運用醫護與安寧共照跨專業團隊資源，透過轉移注意力、精油按摩、聆聽音樂及生命回顧並配合醫療處置減輕疼痛；教導物理方式促進痰液排出，使肺部浸潤情形改善；在跨團隊專業協助下，引導家屬以正向的態度面臨即將失去至親的哀傷，提供全人護理以達善終。

關鍵字

疼痛；呼吸道清除功能失效；預期性哀傷；生命回顧

並列摘要

This article describes the experience of interdisciplinary care for a middle-aged male patient with terminal lung cancer coupled with brain metastasis and his family. The patient faced increasing physical fatigue and tremendous psychological impact due to the initial diagnosis of cancer coupled with brain metastasis, and his family members were also facing the imminent death of the patient, and they do not know how to express and deal with the grieving emotion. During the caring period from March 27 to April 28 in 2019, the author applies interviews, observation and Gordon's Eleven Functional Health Patterns to utilized and diagnosed the following major health issues: (1) Acute pain related to brain metastasis of cancer cells; (2) Ineffective breathing pattern that was related to pulmonary infiltration; and (3) Anticipatory grief that was related to the family members' awareness about the imminent death of patient. During the nursing period, the resources of the interdisciplinary team for hospice shared care were utilized, and pain was alleviated through attention shifting, massage with essential oil, listening to music, life review and medical treatment. Physical methods were also taught to facilitate sputum discharge to improve pulmonary infiltration. Under the professional assistance of the interdisciplinary care, the family members were guided to accept the grief of the imminent death of their loved one with a positive attitude, and provide holistic health care to achieve a peaceful death.

並列關鍵字

pain ； ineffective breathing pattern ； anticipatory grief ； life review

參考文獻

王馥亭、鄭逸如、楊于婷、張琦郁、林耀盛、吳治勳、黃靜怡、呂燕茹（2017）‧「我很愛你，我好害怕你會離開我」：由照護癌末病人配偶的經驗反思哀傷之意涵‧安寧療護雜誌，22(3)，333-343 。 https://doi.org/10.6537/TJHPC.201711_22(3).006

江惠英（2015）‧再談團隊資源管理‧領導護理，16(4)，2-10。https://doi.org/10.29494/LN.201512_16(4).0001

洪語壎、鍾淑媛、梁穎（2017）‧一位肺癌末期病人的善終護理經驗‧腫瘤護理雜誌，17，55-67。https://doi.org/10.3966/168395442017101703006

莊祐綸、劉曉君、陳祐蓉（2020）‧運用個別懷舊治療於老年憂鬱症病人之護理經驗‧新臺北護理期刊，22(2)，119-129。 https://doi.org/10.6540/NTJN.202009_22(2).0011

莊莉瀅、劉曉君（2017）‧一位肺癌末期併腦轉移病人之護理經驗‧腫瘤護理雜誌，17(1)，75-86。https://doi.org/10.3966/168395442017061701007

主題瀏覽