- 期刊
照護一位肝癌末期合併腦轉移個案之護理經驗
Clinical Experience of Attending to a Liver Cancer Patient at Terminal Stage with Brain Metastasis
摘要
本文描述一位肝癌末期病人面臨瀕死症狀及家屬預期性哀傷之護理經驗。護理期間自2015年12月22日至2016年1月6日，經由會談、身體評估、觀察及直接照護等方式收集資料，運用Gordon十一項健康功能型態評估進行整體性評估及資料整合分析歸納，確立個案有疼痛、體液容積過量及家屬預期性哀傷等三項健康問題。護理過程中提供舒適擺位、音樂療法、穴位指壓及芳香療法，緩解其疼痛不適；教導指壓按摩、控制低鈉限水飲食及嚴密監測輸出入量等，以改善體液容積過量情形；醫療團隊與個案家庭建立良好護病關係，正視家屬分離焦慮及同理悲傷情緒，正向態度面對並接受死亡議題及處理哀傷情緒。建議醫護同仁重視癌末病人之靈性需求，協助其疾病適應及身心安適，同理家屬哀傷情緒及鼓勵抒發宣洩，使其能獲得適切性照護，以期家庭早日回歸正常化，期望經此照護經驗分享，以供臨床實務參考之用。
並列摘要
This study depicts a clinical experience of caring for a patient with terminal liver cancer confronting the end-of-life symptoms and anticipatory grief of the family. The nursing care was conducted from December 22, 2015 to January 6, 2016. Data were collected through counseling, health assessment, observation, and nursing care. An overall assessment and analytical integration were conducted based on the Gordon 11 Function Health Patterns which confirmed that the patient has three complications: Excessive fluid volume, pain, and anticipatory grief of the family. During the nursing care, massage, sodium-restricted and fluid-restricted diet were employed to relieve the patients of pain and discomfort; close monitoring of fluid build-up in body was done to improve the excessive volume. Also, position adjustment for comfort, music therapy, acupressure, and aromatherapy were employed to alleviate the pains of the patient. The medical team developed a friendly relationship with the family through companionship and listening to the primary caregiver looking for the catharsis therapy. The team also helped the patient to accept palliative care and prepare for death with a positive attitude. We suggest that nursing staff pay attention to spiritual needs of terminal cancer patients, help patients adapt to the liver cancer and promote physical and psychological comfort, sympathize with patients' family, and encourage patients' family to express their emotions. The author hopes that the four suggestions mentioned above could help patients get appropriate care and return to their normal life as early as they can. We hope this clinical nursing practice could contribute to future reference.