運用安寧療護協助一位乳癌末期病患善終之護理經驗

Hospice Care Experience of a Terminal-stage Breast Cancer Patient

陳思廷(Shih-Ting Chen) ； 張馨元(Sin-Yuan Jhang) ； 陳宛榆(Wan-Yu Chen)

《腫瘤護理雜誌》 19卷增訂刊 (2019/03) Pp. 89-99

https://doi.org/10.6880/TJON.201903/SP_19.08

摘要

癌症年輕化，養育子女階段的病患經歷疾病進展、死亡及道別，對病患與家庭是衝擊，對醫護團隊更是一大挑戰。本篇主要探討一位乳癌末期病患在腫瘤病房進行症狀控制與協助善終的護理經驗。自2015年7月25日至8月24日護理照護期間及後續訪視，運用直接護理、觀察、會談及查閱病歷等方式收集資料，依生理、心理、社會、靈性及家庭層面進行整體性評估，確立主要健康問題有：疼痛、預期性哀傷、家庭因應能力失調。筆者於照護過程中協調個案與家人的想法，以安寧照護為目標，運用完整淋巴水腫治療、精油芳療與藥物控制增強個案自我照顧及減緩疼痛；並協助家人間情感連結，運用美術療育協助個案及家庭成員進行生命回顧，肯定其生命意義；與安寧共照合作，召開多次家庭會議，確認目標並完成，依個案心願，舉辦生前告別會，完成四道人生，個案在轉院一星期後安詳離世。藉由分享此照顧經驗提供日後照顧類似個案之護理人員參考。

關鍵字

乳癌 ； 安寧療護 ； 善終

並列摘要

As the cancer trend has become increasingly prevalent among the younger population, young patients faced with disease progression, death, and saying goodbyes to their young children gradually form growing impacts on not only themselves and their families but also the healthcare team. This case report discusses nursing care experience of a young terminal stage cancer patient in oncology wards for symptom control and hospice care. From July 25 to August 24, 2015, data were collected through direct care, observation, interviews and medical record review in a series of follow-up visiting. Through comprehensive evaluation in the physical, psychological, social, spiritual and family aspects, we identified the main health problems as follows: pain, anticipatory grief and compromised family coping. The author aligned the thoughts of the patient and family, adhered to the concept of hospice care, pharmacological and non-pharmacological interventions, such as lymph massage, aromatherapy and drugs control, to alleviate the pain and establish the self-care ability. Author also assisted the family members in making re-connections using art therapy, life review and living funeral. Joined by the hospice team, the author used family meeting to help patient and family confirm life's meaning and complete life's goals. This patient and her family were able to achieve the goal of facilitating expression of love, repentance, gratitude and farewell as well as a good death. We hope, by sharing this case report, to improve nursing care for other similar situations.

並列關鍵字

Breast cancer ； Hospice care ； Good death

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