照護一位年輕末期卵巢癌個案的護理經驗

本篇個案報告是描述一位罹患卵巢癌末期的年輕女性，在面對死亡時感到焦慮、害怕，及家人對於醫療計畫想法不一致，造成彼此關係緊張，甚至嚴重衝突，故引發筆者書寫的動機。護理期間自2013年11月8日至2013年12月3日，運用Gordon十一項健康功能評估，藉由觀察、傾聽、會談、身體評估及提供直接護理照護等方式收集資料，發現個案及其家庭主要護理問題有急性疼痛、家庭哀傷歷程、死亡焦慮等。在護理過程中，運用跨團隊照護模式，協助個案在有限的日子裡，減緩疼痛不適、降低對死亡的焦慮，並協助個案及家屬建立良好信任關係，主動關懷並深入了解其內心感受，以全人、全家、全程、全隊照護，解決家庭面對親人罹癌末期醫療處置抉擇的衝突，與親人即將辭世的哀傷過程。期望此護理經驗分享，可提供護理同仁照護類似個案之參考。

關鍵字

卵巢癌；死亡焦慮；安寧照護；癌症末期；家庭哀傷

並列摘要

This case report describes the nursing process of caring for a young woman with advanced ovarian cancer. We report the experience of helping this young woman and her families in face of impending death. During the hospitalization, this patient experienced anxiety and fear of death, as well as family conflicts such as arguments and tension due to differences in the expectation of the treatment plan. The authors collected data through direct nursing care, physical assessments, observation, and interviews guided by the Gordon 11-functional health assessment between November 8th, 2013 and December 3rd, 2013. The results revealed that the patient experienced three health problems, including 'acute pain', 'compromised family coping' and 'death anxiety' during the final stage of her life. Being the primary nurse, the author provided care according to four core values of hospice palliative care (i.e., holistic care, family care, team care, and continuing care) to comfort the acute pain experienced by the patient, as well as to encourage and support the patient and her family members through employing a multidisciplinary team to reduce death anxiety. These interventions helped family members to reach the acceptable treatment goals, improve the quality of life and promote peaceful death for this advanced cancer patient. This care experience is expected to provide a valuable reference for clinical practice to develop a family-centered approach to palliative care for advanced cancer patients.

並列關鍵字

ovarian cancer ； death anxiety ； hospice care ； advanced cancer ； grief of family

參考文獻

Javier, N. S. C., & Montagnini, M. L. (2011). Rehabilitation of the hospice and palliative care patient. Journal of Pallitive Medicine,14(5), 638-648. doi:10.1089/jpm.2010.0125

李耀泰、陳福民、李文琮、郭宗正（2011）‧卵巢癌的篩檢‧中華民國婦癌醫學雜誌，（2），26-38。