一位直腸癌末期病患面對死亡之照護經驗

The Nursing Experience of an End-Stage Rectal Cancer Patient

莊涵淳(Han-Chun Chuang) ； 林素慧(Su-Hui Lin) ； 黃春霞(Huin-Hsia Huang)

《腫瘤護理雜誌》 19卷1期 (2019/06) Pp. 77-89

https://doi.org/10.6880/TJON.201906_19(1).07

摘要

本文為協助一位直腸癌末病患及家屬面對死亡害怕與焦慮之經驗分享。個案此次入院即被告知癌細胞有轉移情形且無法治癒，使其及家屬面臨了死亡帶來的衝擊與無法接受，護理期間2016年9月2日至9月12日，運用Gordon十一項功能性健康型態評估，透過整體性評估、觀察、傾聽及持續性的關懷與陪伴收集個案身體、心靈與社會方面等主、客觀資料，確立個案有四項主要護理問題：低效性呼吸型態、睡眠型態紊亂、死亡焦慮、預期性哀傷。筆者藉由建立良好的護病關係並與醫療團隊合作，主動關懷、傾聽與陪伴個案及家屬，運用藥物與非藥物治療等措施給予個別性照護，增進其身、心舒適；協助個案回顧生命歷程，鼓勵個案與家屬說出心中感受並運用四道人生（道謝、道歉、道愛、道別）引導臨終道別，陪伴個案走完人生最後旅程，以降低其對死亡的焦慮與害怕，增進心靈舒適，並於生命終點時能有尊嚴善終，期望本篇照護經驗可供醫護人員於臨床照護上之參考。

關鍵字

睡眠型態紊亂 ； 死亡焦慮 ； 預期性哀傷

並列摘要

The report is based on the nursing experience of a terminal stage rectal cancer patient and the family to overcome the fear of death. The patient was informed that the cancer had metastasized without a cure when he was admitted to the hospital. The patient and his family found it unacceptable and impossible to face the impact of death. The nursing care period was from Sep. 2 to Sept 12, 2016. Through observation, listening and application of Gordon’s 11 Functional Health Patterns, author evaluated areas that covered the patient’s physical, psychological, social and spiritual realms. During the care period, patient’s major health problems identified were: Ineffective breathing pattern, sleep disorder, death anxiety and anticipatory grief. By giving proactive care, listening, and accompaniment, author built a good nurse-patient relationship with the patient and his family. By Providing individualized comprehensive nursing care through team work, authors encouraged patient and family to express their feelings to reduce the anxiety and fear of death. By introducing four themes of life: Gratitude, Apology, Love, and Farewell, author was able to assist the patient to achieve physical, psychological, and spiritual comfort as well as the concept of good-death domain. This nursing experience may provide other clinical nurses with a different and practical perspective in delivering quality meaningful end-of-life care.

並列關鍵字

sleep pattern disturbed ； Death anxiety ； Anticipatory grief

參考文獻

Brown, A. J., Shen, M. J, Ramondetta, L. M., Bodur-ka, D. C., Giuntoli, R. L. II., & Diaz-Montes T. (2014). Does death anxiety affext end-of-life care discussions? International Journal of Gynecolog Cancer, 24(8), 1521-1526. doi:10.1097/IGC0000000000000250.

丁靜儀、周繡玲（2012）．照顧一位肺癌末期患者面臨倫理困境之護理經驗．腫瘤護理雜誌，12（1），71-83。[Ting, C. I., & Chou, H. L. (2012). The experience of nursing care for a terminal stage lung cancer patient facing ethi-cal dilemma.The Journal of Oncology Nursing, 12(1), 71-83.]

田昕禾、蘇怡勳、陳婉宜、陳嘉瑩（2015）．一位罹患胰臟癌末期病人面對死亡衝擊之護理經驗．腫瘤護理雜誌，15（1），73-84。[Tien, H. H., Su, Y. H., Chen, W. Y., & Chen, C. Y. (2015). A terminal stage patient suffering from pancreatic cancer the impact of the care experience of facing death. The Journal of On-cology Nursing, 15(1), 73-84.]

田彩英（2016）．協助一位肺癌末期患者接受安寧照護之護理經驗．彰化護理，23（1），26-37。[Tien, T. Y. (2016). The hospice nurs-ing experience of a terminal stage patient from lung cancer. Changhua Nursing, 23(1), 26-37.]

行政院衛生福利部（2013，1月9日）．安寧緩和醫療條例．取自http://law. moj.gov.tw/Law-Class/LawAll.aspx?PCode=L0020066 [Min-istry of heath and welfare (2013, January 9th). Hospice Palliative Care Act. Retrieved from http://law.moj.gov.tw/LawClass/LawAllaspx?PCode.=L0020066]