一位口腔癌末期患者之身心靈照護經驗

Nursing Experiences of Caring a Terminal Oral Cancer Patient With Physical, Psychological, and Spiritual Problems

施韋伶(Wei-Ling Shih) ； 郭秋雅(Chiu-Ya Kuo)

《腫瘤護理雜誌》 11卷2期 (2011/12) Pp. 63-74

https://doi.org/10.6880/TJON.201112_11(2).06

摘要

口腔癌是台灣男性惡性腫瘤死亡原因的第四名，本篇是探討一位口腔癌癌症末期病人，因傷口逐漸惡化、疾病無法治癒所面臨的身、心、靈衝擊與調適過程的照護經驗，筆者於2009年6月1日至2009年6月20日照護期間，與病人及家屬建立良好護病關係，利用觀察、會談、身體評估及直接照護等方式，收集資料，運用羅氏適應模式，進行病人生理、心理、靈性等方面評估，發現病人有疼痛、口腔黏膜障礙、身體心像紊亂、無望感及心靈困擾等問題，護理期間，運用護理人員獨特功能，並配合醫療團隊，提供病人藥物、聽音樂及放鬆技巧來緩解病人疼痛；衛教病人口腔清潔及攝取高蛋白軟質飲食，來改善口腔黏膜障礙；鼓勵病人及家屬主動參與換藥，並適時給予鼓勵，使其能以正向心態接受傷口；此外，引導病人回想以往美好事物，肯定生命意義，提升病人自我正向感，改善無望感；運用開放式問句、同理心並傾聽病人心靈困惑，鼓勵病人回憶以往，並借助宗教力量，增強病人自信心，使病人對疾病及治療有正向認知，讓病人在疾病最終一程能得到身心靈舒適。筆者藉此照護經驗分享，期望能提供護理人員在照護類似病人之參考，協助病人自我調適，恢復自信心，提供更完整的照護品質，達到身心靈舒適境界。

關鍵字

口腔癌 ； 末期 ； 照護經驗

並列摘要

Oral cancer is the fourth cause of death in men suffering cancer in Taiwan. This case report is to describe nursing experiences and the adaptation process of a terminal oral cancer patient, who had an incurable disease with gradual deterioration wounds, and who experienced the physical, psychological, and spiritual hits. The authors took care of the patient from June 1 to June 20 in 2009, and established a good therapeutic relationship with the patient and his families. Data was collected by using observation, interview, physical assessment, and direct patient care, etc. In addition, Roy's adaptation model was used to assess the patient's physiological, psychological and spiritual dimensions, and the patient problems were identified as pain, oral mucosal membrane impaired, body image disturbed, hopelessness, and spiritual distress. During the nursing process, the health care team administered medications, and used music therapy and relaxation techniques to relieve the patient's pain. The authors educated the patient oral hygiene health and the intake of high protein soft diet to improve the impaired oral mucous. In addition, the authors encouraged the patient and families to actively participate in wound care, and accept the wound in positive attitudes by guiding the patient to recall the good things in the past, confirming the meaning of life, and promoting the positive sense of self. The authors also improved the patient's hopelessness by using open-ended questions, empathy and listening to the patient mind-spiritual confusion, and encouraged him to do life review and enhanced his self-confidence through religious forces. Finally, the patient gained a positive awareness of his disease, and got physiological, psychological and spiritual comfort at the end of his life. By sharing the experience of care, it is expected that the case report could guide nurses to take care of similar patients through helping them self-adjust and restore confidence, and to provide a more complete care quality, and to achieve the realms of body-mind-soul comfort.

並列關鍵字

ooral cancer ； end of life ； experience of care