照顧一位乳癌合併多處轉移病人之安寧療護經驗

Nursing Experience of a Breast Cancer Patient With Multiple Metastasis Receiving Hospice Care

江瑋婷(Wei-Ting Chiang) ； 施秀鈴(Hsiu-Ling Shih) ； 潘雪幸(Hsueh-Hsing Pan)

《腫瘤護理雜誌》 16卷1期 (2016/06) Pp. 47-60

https://doi.org/10.3966/168395442016061601006

摘要

本篇報告是探討一位罹患右側乳癌合併多處轉移的個案，入住安寧病房行症狀控制及善終的護理經驗。照護過程中，發現家屬面對個案死亡的迫近，出現暗自落淚及茶飯不思的情形，言談中也表達對個案的不捨，其不安的程度隨著個案病況變差而日漸增加，出現嚴重的預期性哀傷反應，因此引起筆者探討之動機。護理期間自102年10月10日至10月20日，藉由會談、傾聽、身體評估、護理紀錄，並運用生理、心理、社會、靈性之整體性評估收集資料，發現個案有呼吸道清除功能失效、自我照顧能力缺失及預期性哀傷等健康問題。護理過程中與個案建立良好治療性關係，透過主動關懷、傾聽、陪伴，依據安寧照護理念，以病人舒適為中心，提供適當之身體及症狀照護，並給予案家屬心理支持，讓個案之護理問題得以改善，並使個案及家屬能以正向的態度，渡過疾病過程，達到身、心、靈之平安。建議可善用同理心與個案及家屬進行溝通，了解其相關互動及困難處，並學習及嘗試以個案的身分角色，向家屬表達愛及感謝，並建議在護理養成教育時，加強照護個案之正確觀念及態度，加深同理心的培養，使病人得到更好的醫療及照護品質。期望藉此個案護理過程作為分享，提供日後照顧此類個案的護理人員做參考。

關鍵字

乳癌 ； 預期性哀傷 ； 安寧療護

並列摘要

The aim of this study was to explore the nursing experience of caring for a hospice patient with right breast cancer and multiple metastases from 102/10/10 to 102/10/20. During the period of caring, the author noticed the family wasted by the fear of death. They were suffering from sadness, helplessness and separation depression which increased as the patient's condition worsened. This prompted the author to assess the patient's physical, psychological, social and spiritual needs and collect data through observation, listening, interview, physical assessment, medical records and other methods. Problems noted were ineffective airway clearance, selfcare deficit and anticipatory grief. Following the concept of hospice care and centering on the comfort of patient, we established a good therapeutic relationship with the patient by showing we care, listening, and by offering companionship. While we provided the patient with symptomatic care, we gave the family psychosocial support. We helped them face the disease progression with a positive attitude and achieve the physical, psychological and spiritual peace. We suggested them to communicate with one another by way of empathy. We learned from their difficulty of interaction and we also learned to convey the patient's gratitude and love to the family. Now we see the needs for more emphasis on empathy and correct attitude in the nursing education, which leads to better patient care and nursing quality. We hope our experience can be used as useful reference for the future.

並列關鍵字

breast cancer ； anticipatory grief ； hospice care

參考文獻

趙可式（2009）．台灣安寧療護的發展與前瞻．護理雜誌，56（1），5-10。[Chao, C. S. (2009). Development and Prospects of Hospice Palliative Care in Taiwan. The Journal of Nursing, 56(1), 5-10. doi: 10.6224/JN.56.1.5]

Booth, S., Moosavi, S. H., & Higginson, I. J. (2008). The etiology and management of intractable breathlessness in patients with advanced cancer: A systematic review of pharmacological therapy. Nature Clinical Practice Oncology, 5(2), 90-100. doi: 10.1038/ncponc1034

Hauser, J., Sileo, M., Araneta, N., Kirk, R., Martinez, J., Finn, K., ... Rodrigue, M. K. (2011). Navigation and palliative care. Cancer, 117(15), 3585-3591. doi: 10.1002/cncr.26266

White, D. B., Cua, S. M., Walk, R., Pollice, L., Weissfeld, L., Hong, S., ... Arnold, R. M. (2012). Nurse-led intervention to improve surrogate decision making for patients with advanced critical illness. American Journal of Critical Care, 21(6), 396-409. doi:10.4037/ajcc2012223

王俐絜、陳威宇、張書展、黃安年、洪榮駿、王瑞霞（2011）．消化道末期癌症病患居家主要照顧者之照顧負荷與其相關性因素探討．護理雜誌，58（6），54-65。[Wang, L. C., Chen, W. Y., Chang, S. C., Wong, J. O. N., Hong, R. J., & Wang, R. H. (2011). Caregiving burden and associated factors among caregivers of terminally ill gastrointestinal cancer patients. The Journal of Nursing, 58(6), 54-65.]