照護一位肺癌併發骨轉移病人之照護經驗

Nursing Experience of a Lung Cancer Patient with Bone Metastasis

李欣娜(Lee Shin-Na) ； 林靖芸(Jing-Yun Lin)

《腫瘤護理雜誌》 17卷2期 (2017/12) Pp. 93-105

https://doi.org/10.3966/168395442017121702008

摘要

本文描述照護一位肺癌併發骨轉移病人之護理經驗，護理期間為2014年9月15日至10月14日，住院期間筆者採用觀察、會談、身體評估技巧，運用Gordon十一項功能性健康型態評估，發現個案有疼痛、無望感、照顧者角色緊張等健康問題。在照護過程中，經與安寧跨領域團隊合作，提供症狀減緩治療，藉由藥物及非藥物之止痛方式及放鬆技巧減輕疼痛，舒緩不適症狀；建立良好的護病關係，利用傾聽、溝通及同理心技巧，接受其情緒反應，運用生命回顧，使個案重拾對生命價值、意義及家庭成員之間的愛與關懷，改善無望感之負向情緒；會同安寧共照師教導案妻與其家屬學習個別性的照顧技巧，分擔照護責任，減輕案妻照顧壓力與焦慮，進而提升病患之整體性照護。期望藉此個案報告之照顧經驗，做為日後照護此類病患的醫療人員參考。

關鍵字

肺癌 ； 骨轉移 ； 疼痛 ； 照顧者角色緊張 ； 無望感

並列摘要

This article describes the nursing experience of a patient with bone metastasis from lung cancer during the period from September 15 to October 14, 2014. Observations, interviews, and physical examinations were performed during hospitalization and an assessment based on Gordon’s 11 functional health patterns identified the following healthcare problems: pain, sense of hopelessness, and caregiver anxiety. Symptom mitigation was provided during the nursing process in collaboration with a hospice team. Symptom relief was achieved via pharmacological and non-pharmacological pain treatments and the use of relaxation techniques for pain relief. In order to establish an successful relationship with the patient, listening, communication, and empathy skills were used to recognize the patient’s emotional response. Life review therapy helped the patient restore his love and appreciation for life and family members, and reduce the negative emotion of hopelessness. The overall patient care was further improved through providing the patient's wife and family members with instructions from a hospice caregiver regarding nursing techniques, shared care responsibilities, and reduction of stress and anxiety for the patient’s wife. It is hoped that the nursing experience described in this case report can serve as a reference for medical personnel handling similar cases.

並列關鍵字

lung cancer ； bone metastasis ； pain ； caregiver role anxiety ； hopelessness

參考文獻

洪淑惠、張肇松、林淑媛、謝秀芳（2009）．癌末病患主要家屬照顧者照顧負荷及其影響因素之探討．護理暨健康照護研究，5（3），163-172。[Hong, S. H., Chang, C. S., Lin, S. Y. & Hsieh, H. F. (2009). Factors associated with caregiver burden in families of terminal cancer patients. Journal of Nursing and Healthcare Research, 5(3), 163-172. doi:10.6225/jnhr.5.3.163]

蕭佳莉、邱啟潤（2011）．居家照護病患之主要照顧者正負向照顧經驗及其相關因素之探討．護理暨健康照護研究，7（2），127-139。[Hsiao, C. L. & Chiou, C. J. (2011). Primary caregivers of home care patients to take care of the positive and negative experiences and to explore the related factors. Journal of Nursing and Healthcare Research, 7(2), 127-139. doi:10.6225/JNHR.7.2.127]

李秋香、顏文娟、黃秀梨（2009）．無望感之概念分析．嘉基護理，9（1），7-11。[Lee, C. H., Yan, W. J., & Wong, S. L. (2009) .The concept of analysis hopelessness. Ditmanson Medical Foundation Chiayi Christion Hospital Journal of Nursing, 9(1), 7-11.]

李昕宜、許玉娟、陳佳慧（2014）．癌症生存者之困擾症狀．台灣醫學，18（3），355-360。[Lee, H. Y., Xu, Y. J., & Chen, C. H. (2014). Troublesome symptoms in cancer survivors. Formosan Journal of Medicine, 18(3), 355-360.]

邱子易（2007）．芳香療法於安寧緩和療護之應用．安寧療護，12（3），332-337。[Chiu, Z. Y. (2007). Aromatherapy in palliative application of palliative care. Taiwan Journal of Hospice Palliative Care, 12(3), 332-337.]