運用生命回顧法於一位肺癌末期個案及其家屬之護理經驗

A Nursing Experience of Application of Life Reminiscence for a Patient and Families of Terminal Stage with Lung Cancer

周冠妘(Kuan-Yun Chou) ； 謝春金(Chun-Chin Hsieh)

《新臺北護理期刊》 20卷1期 (2018/03) Pp. 143-151

https://doi.org/10.6540/NTJN.2018.1.013

摘要

本文乃運用生命回顧法，照顧一位80歲肺癌末期之個案，對未來產生無望的護理經驗。自2014年12月12日至19日，藉由直接照護、觀察、會談及觀察家庭互動等方式，並運用整體性評估，收集身、心、社會與靈性層面等資料，歸納出個案有慢性疼痛、無望感及家屬意識到個案將不久人世而有預期性哀傷等健康問題。經由主動關懷建立信任護病關係，運用疼痛十分量表評估疼痛指數，鼓勵其表達對疼痛的感受，並藉由獨特性的護理措施，穴位按摩及音樂轉移注意力來減輕疼痛；引導家屬陪伴，鼓勵個案說出內心真實感受；更透過傾聽與生命回顧，引導家屬面對個案即將死亡的事實，彼此敘說內心對個案的感謝及死亡的準備。期望藉此護理經驗分享，作為照護此類病人的參考。

關鍵字

肺癌末期 ； 無望感 ； 預期性哀傷 ； 生命回顧

並列摘要

This report described a special nursing experience applying life reminiscence for an 80 year-old patient diagnosed with terminal stage lung cancer who felt hopeless. From December 12 to 19 in 2014, through direct care, conversation, and observation of families' interaction to collect data from physical, psychological, and spiritual respects, we concluded that this patient had chronic pain, hopelessness, and anticipatory grief due to limited remaining life. By active care to build mutual trust and application of 0-10 Numeric Pain Rating Scale, we precisely evaluated this patient's pain severity and encouraged this patient to express his pain experience, including lung cancer, hopelessness, anticipatory grief, and life reminiscence. We also applied acupuncture point massage with essential oil and his favorite music to relieve the pain. As this patient felt hopeless, we suggested families' accompany and life reminiscence to help this patient express his true feelings. Through listening, guiding families to face the truth of this patient's impending death, and encouraging them communicate with others about their true feelings, we successfully attenuated families' sorrow. We expected this special nursing experience could benefit our colleagues to take care of similar cases.

並列關鍵字

terminal stage of lung cancer ； hopelessness ； anticipatory grief ； life reminiscence

參考文獻

王麗慧、李淑秋、胡瑞桃（2010）‧照護一位加護病房肺癌末期病患之護理經驗‧新臺北護理期刊，2（2），91-99。doi:10.6540/NTJN.2010.2.010

徐偉勛、李日翔、林家齊、楊志新（2014）‧肺癌嶄新標靶治療研究現況‧台灣醫學，18（6），688-694。doi:10.6320/FJM.2014.18(6).09

陳月蓉、王雅芳、郭淑華、楊婉萍（2015）‧心慟不捨中放手祝福：一位末期肺癌病人之家屬預期性哀傷撫慰‧安寧療護，20（1），79-87。doi:10.6537/TJHPC.2015.20(1).7

喬聖琳、林意旋、陳俊良、楊賢鴻（2015）‧中醫醫療結合芳香療法研究國際醫療之願景‧中醫藥雜誌，26（2），1-13。doi:10.3966/241139642015122602007

黃惠美、郭素真、王靜慧、張議文、周幸生（2012）‧建立成人癌症病人疼痛非藥物處置之臨床照護指引‧榮總護理，29（2），145-158。doi:10.6142/VGHN.29.2.145