運用Watson關懷理論於首次接受免疫療法之肺癌個案照護經驗

Applying Watson's Theory of Human Caring to the First Case of Immunotherapy for a Lung Cancer Patient

王嘉華(Jia-Hua Wang) ； 胡儷馨(Li-Shin Hu)

《腫瘤護理雜誌》 19卷1期 (2019/06) Pp. 65-75

https://doi.org/10.6880/TJON.201906_19(1).06

摘要

本文運用Watson關懷理論於首次接受免疫療法之肺癌個案照護經驗。照護期間自2017年7月13日至2017年8月7日，以人性化關懷精神為導引，藉由直接照護、觀察、會談與病歷查閱方式收集資料，確立有「低效性呼吸型態」、「疲憊」及「預期性哀傷」等健康問題。透過與個案建立良好治療性關係，並運用跨團隊整合資源方式提供肺部復健運動改善呼吸功能；適時提供日常活動能量保留方法及漸進式運動訓練，改善疲憊感並且學習居家照護等技巧；另外面對生命日漸流失的恐懼與悲傷感，醫護團隊給予完善說明照護目標，藉由教友支持信仰靈性的寄託，適時回顧一生正向鼓勵肯定，減輕其身、心、靈社會層面壓力衝擊，達成無憾人生初衷。此個案為院內首例接受免疫療法者，期望照護經驗可供護理人員日後關懷此類個案之參考。

關鍵字

Watson關懷理論 ； 癌症 ； 免疫療法 ； 靈性照護

並列摘要

This article uses Watson's caring theory for first-time lung cancer case care with immunotherapy. During the period of care, from July 13, 2017 to August 7, 2017, guided by the spirit of humane care, information was collected through direct care, observation, talks and medical records to establish ＂ineffective breathing patterns ＂,＂ Tired ＂and＂ expected sadness ＂and other health problems. Through the establishment of a good therapeutic relationship with the case and the use of cross-team integration of resources to provide pulmonary rehabilitation exercise to improve respiratory function; timely provision of daily energy retention and progressive exercise training methods to improve fatigue and learning home care skills; the other Faced with the loss of life's fear and sadness, the health care team has given a sound explanation of the goal of care. With the support of the faithful in support of spiritual beliefs, the medical team promptly and positively encouraged and affirmed its life and mitigated the pressure and impact on the body, mind and spirit at the social level. No regrets in mind. This case is the first case of receiving immunotherapy in the hospital and it is expected that the care experience can be used as a reference for carers in future care of such cases.

並列關鍵字

Watson Care Theory ； Cancer ； Immunotherapy ； Spiritual Care

參考文獻

陳淑芬、高淑雰、劉曉君、郭鳳霞、洪世欣（2012）．建立成人癌因性疲憊非藥物處置之臨床照護指引．榮總護理，29（4），382-394。[Chen, S. F., Gao, S. Y., Liu, X. J., Guo, F. G., & Hong, S. X. (2012). Establishing adult cancer fatigue non-drug treatment clinical care guidelines. VGH Nursing, 29(4), 382-394.] doi:10.6142/VGHN.29.4.382

陳依萍、黃鳳玉（2013）．一位肺癌末期病人善終之護理經驗．榮總護理，13（1），103-110。[Chen, Y. P., & Huang, F. G. (2013). A nursing experience of hospice in patients with advanced lung cancer. VGH Nursing, 13(1), 103-110.] doi:10.6142/VGHN.30.1.103

郭弘揚、施金元、廖唯昱、余忠仁（2014）．免疫核對點抑制劑在非小細胞肺癌的治療．台灣醫學，18（4），681-687。[Guo, H. G., Shi, J. Y., Liao, W. Z., & Yu, Z. G. (2014). Immune checkpoint inhibitors are not small treatment of cell lung cancer. Taiwan Medical, 18(4), 681-687.] doi:10.6320/FJM.2014.18(6).08

Hodi, F. S., O’Day, S. J., McDermott, D. F., Weber, R. W., Sosman, J. A., Haanen, J. B., ... Urba, W.J. (2010). Improved survival with ipilim-umab in patients with metastatic melanoma. The New England Journal of Medicine, 363(8), 711-723. doi:10.1056/NEJMoa1003466

Kirshbaum, M. (2010). Cancer-related fatigue: A re-view of nursing interventions. British Journal of Community Nursing, 15(5), 214-216, 218-219. doi:10.12968/bjcn.2010.15.5.47945