照護一位診斷惡性肋膜間皮瘤病人之護理經驗

Nursing Experience of Caring for a Patient Diagnosed with Malignant Pleural Mesothelioma

洪家琦(Chia-Chu Hung) ； 林美惠(Mei-Hui Lin)

《新臺北護理期刊》 24卷2期 (2022/09) Pp. 147-156

https://doi.org/10.6540/NTJN.202209_24(2).0014

摘要

本文探討一位惡性肋膜間皮瘤病人之護理經驗，病人因疼痛問題而入院治療，住院期間有呼吸不適及疼痛等問題，且主治醫師告知存活期不長，面對即將死亡的噩耗出現心靈困擾的問題，因此引發筆者撰寫動機；照護期間為2018年6月21日至2018年7月15日，透過觀察、會談、身體評估、查閱病歷及團隊討論方式，依生理、心理、社會及靈性層面針對病人做全面性評估，確認住院期間有：無效性呼吸型態、疼痛及心靈困擾等健康問題，照護期間透過協助病人採取半坐臥姿勢及噘嘴式呼吸技巧來促進肺部擴張，並運用手持電風扇來增加空氣對流循環，成功緩解呼吸困難；針對疼痛使用芳香療法按摩、音樂療法及穴位按壓等方式，使病人緩解疼痛問題；此外在照護過程中建立治療性人際關係，透過家庭會議、協助舉辦女兒生日會、運用生命回顧及藉由宗教力量，引導病人尋求人生意義達到靈性安適，此外血液腫瘤科的醫護人員面對生離死別的頻率較高，故建議各醫院開辦醫護人員相關正念減壓課程及心理紓壓活動，讓醫護人員能在照護病人的過程中能擁有身、心、靈健全的狀態，更能發揮安寧療護的精神進而提升護理品質。

關鍵字

惡性肋膜間皮瘤 ； 癌症 ； 疼痛 ； 心靈困擾

並列摘要

This article presents the nursing experience of a patient diagnosed with malignant pleural mesothelioma. This time he was admitted to the hospital for pain control, and he had breathing and pain problems during hospitalization. The doctor told him that his life span would remain not long after. The duration of nursing care for the patient was June 21 to July 15, 2018. Through interview, observation, and listening, collection and compilation of the related information were carried out according to the physical, psychological, social and spiritual aspects of the patient. Then the paper determined the health concerns of this patient, including ineffective breathing patterns, pain and spiritual distress. In the nursing process, semi-sitting and pursed-lip breathing to promote lung expansion, hand-held electric fans to relieve breathing difficulties, and aromatherapy massage, music therapy and acupressure massage to relieve pain were used. Moreover, we helped him build therapeutic interpersonal relationship through family conference, holding daughter birthday party, using life review, and borrowing the power of religion to guide this patient to seek the meaning of life to achieve spiritual comfort. Furthermore, because nurse staff of Hematology and Oncology face life and death more frequently, it is recommended that all hospitals conduct a Mindfulness-Based Stress Reduction (MBSR) lecture to allow medical staff to have a sound state of body, mind, and spirit in the process of caring for patients, and to give full play to the spirit of tranquility and treatment to improve the quality of care.

並列關鍵字

malignant pleural mesothelioma ； cancer ； pain ； spiritual distress

參考文獻

汪雅婷（2016）‧音樂療法實踐與研究之挑戰‧發展與前瞻學報，11，53-61。

吳尚倫、謝政智（2017）‧癌症相關疼痛之藥物治療新觀念‧臺灣臨床藥學雜誌，25（2），100-108。

陳麗麗、林君黛（2015）‧穴位按壓與實證護理‧護理雜誌，62（6），27-34。

陳瑞棉、莊琮凱（2017）‧精油種類與嗅吸時間長短對人體自律神經之影響‧中醫本草芳香療法期刊，1（1），5-18。

張碧華、許帆媗、江秀慧、劉怡伶、陳美玉、吳佳蕓、張基晟（2016）‧多團隊呼吸困難照護群組在肺癌住院病人呼吸困難之臨床應用‧腫瘤護理雜誌，16，57-74。