協助一位重症肺癌末期病人預立醫療決策之護理經驗

本文為一位肺癌末期個案於門診化學治療時因過敏性休克經心肺復甦術後之加護護理經驗。於2015年3月16日至3月31日，透過筆談、會談、身評及Gordon十一項功能性健康型態進行評估，確認有氣體交換障礙、決定力增進的準備度與照顧者角色緊張等健康問題。藉由關懷與陪伴建立良好護病關係，提供病情訊息，降低家屬的焦慮情緒；協助個案執行肺部復健運動、順利脫離呼吸器後轉出加護病房；運用安寧理念引導個案和家屬正視預立醫療決策，訂定符合心願的末期醫療照護計畫，透過家人及宗教的支持獲得心靈安適、返家安詳善終。建議醫療團隊應早期引導癌末病人預立醫療決策，並鼓勵其家人參與照護計畫。

關鍵字

肺癌末期；預立醫療決策；重症護理

並列摘要

This article described a nursing experience of an end-stage lung cancer patient who were resuscitated by CPR after severe allergic shock during chemotherapy and underwent endotracheal intubation combined with ventilator. Data were collected during the nursing period from 16th to 31st March, 2015, with Gordon's 11 functional health assessment as framework, via conversations by writing, interviews, and physical examinations. The following nursing issues were identified: impaired gas exchange, readiness for enhanced decision making, and caregiver role strain. We built a positive nurse-patient relationship through care and company, and reduced the anxiety of the family members by providing disease information; successfully weaned the patient off of the ventilator and transferred out of ICU by assisting the patient with lung rehabilitation exercise. By employing the concept of palliative care, the patient and the family were guided to face the importance of drafting advance directive, and to plan desired advance care planning. With the support and consolation from family and religion, the patient attained spiritual comfort, returned home and passed away in peace. We recommend all medical teams to guide end-stage cancer patients in drafting advance directives as early as possible, and encourage their family to participate in care plan.