一位乳癌復發個案面臨死亡恐懼之案例報告

NURSING EXPERIENCE OF CARING FOR A PATIENT WITH RECURRENT BREAST CANCER

賴思瑜(Ssu-Yu Lai) ； 黃思緯(Ssu-Wei Huang) ； 江淑娟(Shu-Jiuan Jiang) ； 吳美娟(Mei-Chuan Wu) ； 謝嘉琪(Chia-Chi Hsieh)

《秀傳醫學雜誌》 18卷2期 (2019/12) Pp. 137-146

https://doi.org/10.3966/156104972019121802008

摘要

本文探討一位乳癌復發面臨死亡恐懼之護理經驗，於2017/7/16-7/22運用Gordon十一項健康功能型態評估，經由觀察、會談及身體評估等方式蒐集資料，確立個案的護理問題有急性疼痛、死亡恐懼及家庭因應能力失調。照護過程中，提供個別性的護理措施，教導疼痛控制技巧；以同理心的態度建立治療性人際關係，促使個案願意分享內心恐懼的感受，給予宗教信仰及親情的支持，在護理人員的引導及陪伴下，透過心理諮商及介紹成功個案與其會談，使個案能從他人經驗中增強信心，進而緩解對於死亡的恐懼；以及安排家庭會議，建立有效溝通模式，增加彼此間共識，促進家庭因應能力，並與醫療團隊擬定共同的目標，以提升個案的生活品質及正向面對疾病，經此照護經驗深刻了解家庭的支持及心靈安適是非常重要的，建議單位針對心靈層面，加強正確評估及處置能力，方能發揮護理獨特性功能，促使全人護理更加完善。近年乳癌基因檢測發展日趨成熟，卻無法將此高額自費檢測普及至高風險族群，是一大限制，期盼健保政策能發展有效配套措施，落實預防醫學，早期發現早期治療，改善罹病存活率。

關鍵字

復發 ； 乳癌 ； 死亡恐懼

並列摘要

This study explores the experience of nursing a subject with reoccurring breast cancer who is fearing death. Adopting the Gordon 11 Function Health Patterns from July 16th, 2017 to July 22nd, 2017, this study collected data through observation, interviews, and physical assessments, and it was confirmed that the nursing problems of the subject included acute pain, fear of death, and an ineffective family coping strategy. In the care process, individual care measures were provided, and techniques for controlling pain were taught. Meanwhile, the establishment of a therapeutic interpersonal relationship with an empathic attitude prompted the subject to share her inner fear. The religious belief and family support were also encouraged, and under the guidance and companionship of nursing staffs the psychological counseling, briefings of successful cases and conversations helped the subject enhance her confidence through learning about the experiences of others, thus reducing her fear of death. Family meetings were arranged to establish an effective communication model, increase mutual understanding, and enhancing her family coping capabilities. The subject and the medical team established a common goal to improve the quality of the subject's life and help the subject face the disease. Through this care experience, the author deeply understands that family support and mental comfort are very important. This study suggests that competent authorities strengthen the assessment accuracy and handling capabilities for mental aspects, so as to fully exert the unique functions of nursing, as well as to perfect holistic health care. In recent years, the development of genetic testing for breast cancer has become increasingly mature, but the fact that this high-cost self-pay testing cannot be popularized among high-risk groups is a major limitation. This study hopes that effective support measures can be added to the National Health Insurance policy, so that preventive medicine can be implemented to reduce the trend and incidence of breast cancer occurring at younger ages.

並列關鍵字

Recurrent ； Breast cancer ； Fear of death