照顧一位肺癌末期患者面臨倫理困境之護理經驗

The Experience of Nursing Care for a Terminal Stage Lung Cancer Patient Facing Ethical Dilemma

丁靜儀(Ching-I Ting) ； 周繡玲(Hsiu-Ling Chou)

《腫瘤護理雜誌》 12卷1期 (2012/06) Pp. 71-83

https://doi.org/10.6880/TJON.201206_12(1).07

摘要

本文係探討一位肺癌末期併發肋膜積水患者，入住加護病房後行使撤除維生醫療儀器治療的護理經驗。於2009年12月9日至12月20日照護期間，依羅氏適應模式為評估架構，藉由會談、觀察及身體評估等方法收集資料。確立個案的健康問題包括：氣體交換障礙、睡眠剝削、無望感及倫理困境。護理過程中除運用主動關懷、傾聽及陪伴，提供個案生、心、靈的照護外，還包括教導噘嘴式呼吸、適當活動及維持舒適來幫助病人身體氧合功能；利用放鬆技巧、治療性觸摸及環境音量控管提升睡眠品質；鼓勵個案表達對疾病的感受，並透過醫護人員清楚解釋疾病的預後及照護目標，以增強個案正向信心；在面對維生醫療儀器取捨時尊重病人的權利，減少或避免家屬與醫護人員陷入倫理困境；以生命回顧導引，協助患者與家屬面對癌末階段，共同參與未來生活規劃，提供生命最後階段的舒適與尊嚴。期望藉此經驗分享，提供護理人員照護相關末期重症病患之參考。

關鍵字

肺癌 ； 末期 ； 氣體交換障礙 ； 睡眠剝削 ； 無望感 ； 倫理困境

並列摘要

This article described the experience of nursing care for a terminal-stage lung cancer patient with pleural effusion who requested removal of her life support equipment after transferring to the intensive care unit. Data was collected through interviews, observations, and health assessments based on the Roy adaptation model. The patient's health problems were identified as impaired gas exchange, sleep deprivation, hopelessness, and a sense of ethical dilemma. During the nursing process, we expressed caring, actively listened to, and accompanied with the patient, and also provided her with physical, psychological and spiritual care. In addition, we taught the patient pursed-lip breathing, appropriate exercise, and comfort techniques to improve her oxygenation. Furthermore, we used relaxation techniques, therapeutic touch, and noise control to improve sleep quality. We encouraged the patient to express their feelings toward the disease. The physicians also clearly explained the prognosis, and discussed the goals of nursing care with the patient to positively enhance her confidence. We respected the patient's right during the moment when facing the removal or continuation of the life support equipment to reduce or avoid the ethical dilemma for family or care providers. Finally, we provided comfort and dignity to the patient and her family during the terminal stage through life review, and participated in planning the patient's future life. This article is expected to be a reference for nurses who take care of the end-of-life cancer patients.

並列關鍵字

lung cancer ； terminal stage ； impaired gas exchange ； sleep deprivation ； hopelessness ； ethical dilemma