- 期刊
一位轉移性乳癌個案接受化學治療之中西醫結合照護經驗
A Nursing Experience by Integration of Traditional and Western Medicine in a Metastatic Breast Cancer Patient During Chemotherapy
摘要
惡性腫瘤為國人十大死因之首，其中乳癌高居女性癌症發生率第一位。化學治療是轉移性乳癌控制疾病重要的治療方法，但其副作用，卻造成個案生理、心理巨大的衝擊。本文係探討一位轉移性乳癌個案，因骨轉移及化學治療副作用，造成個案身心疲憊而影響行為表現。筆者於2018年10月22至2018年11月27日照護期間，透過中醫整體性評估（望、聞、問、切），並藉由觀察、傾聽、會談、身體評估等方式收集資料，確立個案有慢性疼痛、噁心嘔吐及哀傷等健康問題。於護理過程中結合中醫師、營養師及安寧共同照護成員，提供個案跨團隊照護，並介入拔罐、穴位按壓、耳穴貼壓、音樂治療及膳食療法，有效改善個案疼痛、噁心、嘔吐等症狀。透過生命回顧讓個案自我肯定，藉由宗教信仰提供心理支持，輔以木樂及進行情志療護等，確實降低個案負面情緒表現，讓個案坦然接受死亡。在此照護經驗中，筆者觀察癌末個案因疾病因素常出現情緒起伏，個案內心更深層及靈性層面的照護，是為筆者困難探索之處。現況雖建立癌症個案入院心情溫度計評估機制，但評估重點偏重於自殺防治，故建議在癌症個案的跨團隊照護中，能介入心理師專業心理治療，使乳癌個案照護更臻完善。
並列摘要
This 58 year old female is a case of breast cancer with bone metastasis. She suffered from general malaise due to bone metastasis and side effect of chemotherapy. We assessed the patient through observation, listening, communication, physical examination and four methods of diagnostics in traditional Chinese medicine (TCM) (look, smell and listen, ask, pulse) to confirm that the patient had pain, nausea, vomiting and anticipatory grief from 22nd October 2018 to 27th November 2018. We combined TCM doctor, nutritionist and hospice team with our nursing care. We also used cupping, acupoint compression, ear acupoint, music therapy, and dietetic therapy. Combined with all types of therapy above, nausea, vomiting and pain were improved. The patient got self-confidence through the life review and mental support from her religion. She also received wood music of five-element music and psychotherapy. With all the integrated approach above, the patient reduced the negative affect. She could calmly accept the death. In this nursing experience we found out terminal cancer patients often have depressed mood due to the disease. It is harder to know the inner feeling and spiritual need of the patient. Though we have the mood ranking scale for cancer patients when they admit to our ward, but the mood ranking scale focuses on the prevention of suicide. I suggest the enrollment of psychologists from psychotherapy in the team care of the breast cancer patients. That could make this team more complete.