一位罹患胰臟癌末期病人面對死亡衝擊之照護經驗

癌症末期的病人在面對死亡的衝擊下，心理常會產生焦慮不安、害怕、恐懼等多種負面情緒，在未知的預後及瀕死的心靈掙扎下，癌末病人更需要家人、親友與醫療團隊的關心及支持，使其能正向、積極的面對生命終點的到來。本文旨在探討一位胰臟癌末期病人面對死亡衝擊的照護經驗，筆者於2013年2月20日到2013年3月26日護理期間，以Kubler-Ross提出的「面對死亡五階段論」加以評估，藉由多次深入會談、觀察及查閱病歷等方式收集資料，並將協助個案與家屬面對死亡過程的行為記錄加以分析，確立個案有：1.抑鬱／與癌末病況惡化及腫瘤壓迫不適有關；2.死亡焦慮／與面臨生命末期及反覆出現之症狀有關；3.預期性哀傷／與家人分離的不捨及愧疚感有關。透過主動關懷、陪伴、傾聽個案表達需求與內心感受，並提供個別性心理支持與認知行為等措施，以提升個案的正向態度，減少心理焦慮，降低面對死亡的衝擊。個案出院前即可感受到心情已安適平靜，且可正向面對即將死亡的事實；臨床上常見到癌末個案於生命將走向盡頭時，方發現錯失了許多與家人親近及善終規劃的時機，故期待此篇報告，能夠提供臨床醫護人員如何協助癌末個案及家屬面對死亡的衝擊，以及後續銜接安寧療護之照護，使其能活在當下，做好面對死亡的準備。

關鍵字

胰臟癌末期；死亡衝擊； Kubler-Ross五階段論

並列摘要

Terminal cancer patients in the face of impacts from death often experience anxiety, fear, and other negative emotions. Struggling with the unknown of prognosis and possibly approaching death, the terminal cancer patients require more support from their family, friends, and health care teams to help them move forward with a positive outlook on the end of life. In this paper, the author shares the nursing experience of a terminally ill patient dealing with the impacts of death threat from pancreatic cancer for the period of February 20, 2013 to March 26, 2013. Author used the Five-stage of Grief Model presented by Kubler - Ross to assess the patient. Through in-depth talks, observation, and inspection records, etc., as well as analysis of the information gathered while assisting the patient and family members to face the death, author reached a conclusion that the patient had, 1) depression related to discomfort from terminal cancer and worsened tumor suppression, 2) death anxiety from facing the end of life and the recurring symptoms, and 3) anticipatory grief caused by the anticipated separation from family and other psychiatric issues such as sadness and guilt. Author showed caring, offered companionship, and listened to patient expressing the needs and feelings as ways to provide individualized support, cognitive behavioral psychotherapy, and other care measures in order to promote positive attitude in patient, reduce psychological anxiety and impact from facing death. The patient felt calmed and at peace before discharge and was ready and positive about the facts of death. It's common to see in clinical care that many terminal cancer patients, while struggling with death, miss out on the opportunity for a proper farewell to loved ones and family, or fail to do the hospice planning or final arrangements. Author hopes this report can help clinical staff provide professional assistance to terminal cancer patients and their families in facing the impact from death so they can adjust and subsequently plan for hospice in order to live in the moment while preparing for death.

並列關鍵字

terminal stage of pancreatic cancer ； suffering from the facing death ； Kubler-Ross's five stage model

參考文獻

方俊凱（2008）．談癌症病人及其家屬之心理治療．癌症新探，25期，摘自：http://cisc.twbbs.org/magazine/25.php [Fang, C. K. (2008). About psychotherapy for cancer patients and their families. Cancer Found, 25. Retrieved from: http://cisc.twbbs.org/magazine/25.php]

Google Scholar

李素玲、羅尹淨、劉小蘭、王心潔（2012）．年輕婦女癌末心靈困擾之護理經驗．慈濟護理雜誌．11（4），90-100。[Li, S. L., Lo, Y. C., Liu, H. L., & Wang, H. C. (2012). A nursing experience of a young female terminal cancer patient suffering from spiritual distress. Tzu Chi Nursing Journal, 11(5), 90-100.]

Google Scholar

唐婉如（2008）．癌症病人之靈性評估與照護．腫瘤護理雜誌，8（1），13-24。[Tang, W. J. (2008). Spiritual assessment and care of cancer patients. The Journal of Oncology Nursing, 8(1), 13-25.]

Google Scholar

許文玲、顧雅利（2008）．一位癌末惡性蕈狀傷口個案面臨死亡焦慮之護理經驗．長庚護理，19（4），541-549。[Hsu, W. L., & Ku, Y. L. (2008). Nursing experiences of the malignant fungating wound in a terminal cancer case facing death anxiety. Chang Gung Nursing, 19(4), 541-549.]

Google Scholar

陳敏鋑、黃采薇、趙子傑、簡淑慧、陳秋慧、陳瑞儀⋯顧乃平（2012）．癌症護理學（三版）．台北市：華杏。[Chen, M. C., Huang, T. W., Chao, T. C., Chian, S. H., Chen, C. H., Chen, J. Y., ... , & Ku, N. P. (2012). Oncology nursing (3rd ed.). Taipei City, Taiwan, ROC: Farseeing.]

Google Scholar

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一位罹患胰臟癌末期病人面對死亡衝擊之照護經驗

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