運用安寧療護於一位無望感之肝癌患者的護理經驗

The Nursing Experience of Applying Hospice Care to a Hepatocellular Carcinoma Patient with Hopelessness

林佳吟(Chia-Ying Lin) ； 黃敏瑢(Min-Jung Huang) ； 王妍惠(Yen-Hui Wang)

《高雄護理雜誌》 33卷2期 (2016/08) Pp. 71-81

https://doi.org/10.6692/KJN-2016-33-2-7

摘要

本文描述一位肝細胞癌個案，行經導管動脈化學栓塞術的照護經驗，照護期間2013年9月26日到10月2日，10月2日轉病房，筆者運用生理、心理、社會及靈性之整體性評估，由身體評估、會談、觀察及持續性探訪，收集主、客觀資料，確立其護理問題：疼痛/醫療處置與疾病惡化、焦慮/對病情缺乏控制感與陌生環境、無望感/疾病惡化。筆者有感個案即將走向死亡，於急重症中將安寧療護之精神提供至照護中。照護中予藥物及非藥物治療，如放鬆療法、轉移注意力，協助個案克服疾病導致生理的不適。建立信任感及提升信心，引導與家屬溝通，了解心理感受及想法，緩解焦慮與衝擊，提供心理支持及肯定自我價值；心靈的平靜情緒得以紓解，讓身、心、靈安適達到善終。

關鍵字

肝癌 ； 安寧療護 ； 無望感

並列摘要

This article described a nursing experience of a hepatocellular carcinoma patient with transcatheter arterial chemoembolization. The author took care of the patient from September 26 to October 2, 2013. The patient was transferred to the general ward on October 2. The data were collected by observations, visiting, interviews, and the holistic nursing assessment included physical, psychological, social and spiritual modalities. Three major nursing problems were identified in this case: pain/medical treatment and disease progression, anxiety /loss of control and unfamiliar environment, and hopelessness/disease progression. We were aware the patient was in terminal stage and so provided hospice care in the intensive care unit. During the caring period, the author provided not only administration of drugs but also non-drug therapies such as relaxation and diversion to assist the patient overcome physical discomfort. Furthermore, by guiding family communication with the patient and understanding what the patient's feelings and thoughts were established. The nursing care could relieve their anxiety and psychological impact; even provide mental support, self-affirmation and peaceful spirit. Finally, the patient had holistic well-being and achieved hospice.

並列關鍵字

hepatocellular carcinoma ； hospice care ； hopelessness