- 期刊
運用安寧療護照顧一位乳癌末期病人無望感之護理經驗
Hospice Nursing Experience for a Terminal Breast Cancer Patient in Dealing with Hopelessness
摘要
本文旨在描述一位乳癌末期病人無望感之護理經驗，個案因疾病進展迅速，與團隊互動淡漠、對任何事物皆漠不關心，並透露人生已無任何希望想快點結束生命，充滿負面情緒，引發筆者探討的動機。護理期間自2014年2月11日至2014年3月1日，筆者於照護期間藉由觀察、傾聽、會談、非語言溝通等方式收集主、客觀資料，並運用生理、心理、社會、靈性進行整體性健康評估，發現主要護理問題有：呼吸道清除功能失效、疼痛及無望感。筆者運用個別性護理指導個案與家屬使用正確的咳嗽、姿位引流、背部叩擊、氧氣的使用、詳細的疼痛評估、止痛藥物的調整及舒適臥位、音樂療法及芳香療法，以改善其呼吸道清除失效的問題，並減輕個案的疼痛；透過建立互信的治療性關係、團隊的陪伴與晤談，澄清不正確的訊息，並藉由生命回顧肯定其生命意義與價值，重建其希望，進而達到善終。建議當個案對安寧病房的照顧存有疑慮，可先會診安寧共同照護團隊，或者成立安寧專責諮詢人員，提供更多的安寧療護資訊，讓病人、家屬更加了解安寧療護的理念，在生命末期獲得更有品質的照護。藉此個案護理經驗作為分享，提供日後照顧此類個案的護理人員參考。
並列摘要
This article describes the hospice nursing experience for a breast cancer patient to cope with the sense of hopelessness at the terminal stage. The rapid disease progression caused the patient to experience negative emotions, apathy, and suicide attempt. Patient data were collected through observation, listening, interviews to assess her physical, psychological, social and spiritual issues from February 11 to March 1 in 2014. Three health problems were identified including ineffective airway clearance, pain, and desperation. We provided the patient and her family guidance on the correct cough skill, positional drainage, chest percussion, oxygenation supplement, pain assessment, medication regulation, position adjustment, music therapy and aromatherapy to alleviate ineffective airway clearance as well as pain. By means of establishing mutual trust therapeutic relationship, team companionship and communication, message interpretation, and life reflections, we reaffirmed the patient’s meaning of life and reconstructed the hope to achieve good death. We suggested palliative consult and professional reference who can deliver more information on hospice care so the patient and her families could understand hospice care and improve the quality of care in the end of life. We hope our experience can be shared as a reference to guide future hospice care of similar cases.