- 期刊
運用安寧療護協助一位口腔癌末期病人善終之護理經驗
Hospice Care Experience of Applying Palliative Care to Assist a Terminal-Stage Oral Cancer Patient
摘要
本文探討一位口腔癌末期個案善終之護理經驗，護理期間個案因病情日趨嚴重且腫瘤復發，面臨死亡將近的不安與焦慮，希望能與家人關係破冰和解的盼望，引發筆者探討動機。照護期間自2021年1月26日至2月22日，筆者以生理、心理、社會及家庭、靈性等四大層面評估，確立個案主要有癌症疼痛、組織完整性受損、死亡焦慮等健康問題。護理過程中，筆者偕同安寧療護團隊與個案建立良好的信任關係，以緩解症狀及促進舒適為目標，提供藥物及非藥物的止痛技巧；選擇合適的敷料減少滲液漏出，運用芳香療法降低傷口惡臭；協同靈性關懷師鼓勵個案表達內心的感受，減輕對死亡的恐懼，運用安寧四全照顧理念，居中協調個案及家屬關係上的重建，化解過往的隔閡，透過藝術治療手作過程抒發情感，引導個案向案子道愛親子之情，過程引導四道人生寬恕過去的恩怨，放下心中牽掛。在個案生命最後的旅程，藉由陪伴、傾聽及同理家屬的哀慟及不捨，協助完成個案的心願。最後，建議在疾病尚未進展至末期時，能及早促進個案與家屬溝通取得照護共識，落實全人關壞，重視以家庭為中心的哀傷撫慰。
並列摘要
This study discusses the nursing experience of a terminal oral cancer patient. During the nursing period, which covered from Jan 26 to Feb 22 in 2021, the case was getting more serious and the tumor recurred; facing anxiety as fear of the imminent death, and hoped to break the ice and reconcile with his family, which triggered and motivated the author to discuss. The author evaluates from four aspects such as physical, psychological, social and family, as well as spirituality, hence establishes that the case encountered cancer pain, impaired tissue integrity, and death anxiety. Along with the hospice care team, the author established a trustworthy relationship with the patient during the process, with an aim to relieve his pain using medicine and non-medicine pain relief methods; choosing the appropriate wound dressing to prevent body fluids from infiltrating, as well as using aroma therapy to reduce the odor from the ulcer wounds. Accompanied by our spiritual therapist who constantly encouraged the patient to express his inner feelings to reduce the fear of death; using the concept of four tranquility and all-round care, coordinate the reconstruction of individual cases and family relationships, and resolve the gaps in the past and guide the case to express love for parents and children. The process of guiding the four life lessons to forgive past grievances and let go of worries. By keeping the patient's company during the final stage of his life, listening and sympathizing with the family's grief and sorrows, we were able to fulfill the patient's last wishes. Finally, it is suggested that before the disease progressed to the terminal stage, the communication between the case and the family members can be promoted earlier to reach a consensus regarding care, the implementation of whole-person care, and emphasis on family-centered grief comfort.