協助一位初次診斷大腸癌末期病人面臨之照護經驗

The Nursing Experience of Caring for a Patient at Late Stage under First-time Diagnosis of Terminal Colorectal Cancer

陳思褕(Szu-Yu Chen) ； 沈桂鳳(Kuei-Feng Shen) ； 謝書華(Shu-hua Hsieh)

《高雄護理雜誌》 38卷1期 (2021/04) Pp. 98-109

https://doi.org/10.6692/KJN.202104_38(1).0009

摘要

本文描述一位大腸癌末期合併肝轉移於生命終期的照護經驗。護理期間自2017年12月8日至12月15日，運用觀察、身體評估、陪伴及會談方式進行資料收集，彙整出「營養少於身體所需」、「疼痛」、「死亡焦慮」等主要健康問題。照護期間與營養師共同設計專屬菜單、提供病人慢性疼痛之藥物和非藥物措施；另一方面也以傾聽陪伴、主動關懷，與病人建立良好護病關係，引導其表達心願及討論死亡準備，維護生命尊嚴，透過醫療團隊運用，共同協助個案完成最後一堂課之心願，使得病人能夠放下、安心、不再牽掛，得以善終。藉此經驗分享，讓護理人員能夠了解生命末期病人照護需求，協助個案減輕臨終前的痛苦及完成遺願獲得善終，提升生命末期品質。

關鍵字

大腸癌末期 ； 癌症營養 ； 疼痛控制 ； 死亡焦慮

並列摘要

The article describes The Nursing Experience of Caring for a Patient at Late stage during first-time diagnosis of terminal colorectal cancer. The period of nursing care was from 8 December 2017 to 15 December 2017. The author used thorough actual participation in general assessments, accompaniment, interviews, and other means, so that the health problems of the patient with less nutrition than their body needs, as well as pain and death anxiety were identified. During the care period, the dietitian designed a special menu to provide the patient with chronic pain medications and non-pharmaceutical measures and non-medical therapies to improve the patient's pain. In addition, the techniques of listening, empathy, accompaniment and active care were adopted to establish a good nurse-patient relationship and encourage the patient to express his feelings, and furthermore helping him realize his wish to finish the last class this semester and his post-mortem plans. Team-work and community resources were utilized to help the patient have his wishes come true at this terminal stage. These experiences could be shared as a reference for caring for patients from different cultures and enhancing the quality of hospice care.

並列關鍵字

Terminal stage of colorectal cancer ； Cancer nutrition ； Pain control ； Death anxiety

參考文獻

吳葉書筠、陳幼貴(2019)．一位診斷轉移性大腸癌病人之護理經驗．台大護理雜誌，15(1)，41-52。

李碧玉、柯任桂、顧雅利(2016)．探索老年婦女人生回顧和懷舊活動的個案研究．安寧療護，21(3)，273-288。

杜秀容、劉秀雯、趙珊(2015)．安寧療護之營養照護．北市醫學雜誌，12，173-179。https://doi.org/ 10.6200/tcmj. 2015.12.SP.17

周冠妘、謝春金(2018)．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．新臺北護理期刊，20(1)，143-151。

周雅丹、林佳玉、廖婉君(2015)．一位乳癌末期患者瀕臨死亡之照護經驗．高雄護理雜誌，32(1)，79-90。