照護一位肺癌病人對標靶治療產生不確定感之護理經驗

本文描述一位肺癌行化學治療後，因腫瘤仍未獲得有效控制，改為標靶藥物治療而產生嚴重腹瀉之副作用，並因擔憂治療成效無法如預期恢復而產生身心困擾，陸續出現負向情緒與消極行為。照護期間為2018年3月28日至4月30日，運用羅氏適應模式理論為護理評估之架構，確立個案有排泄型態改變：腹瀉、不確定感及無望感等健康問題，於照護期間除了給予主動關懷，藉由傾聽、陪伴，與個案建立支持及信任關係，深入了解心理需求，引導個案說出自我感受外，另提供正確肺癌相關疾病治療知識與澄清，運用跨領域團隊介入改善腹瀉、皮膚照護，進而調適身、心理壓力所產生的不確定感；透過宗教關懷及生命回顧，引導個案回想過往生命美好事物及主動說出內心疑慮，進而積極配合參與治療計畫，使得內心感到踏實、安心並接受治療，重拾對生命的意義與希望，並能珍惜當下，享受餘生。藉由此護理經驗分享，可提供護理同仁照護類似個案之參考，能更快速明確掌握病人整體狀態，進而提升整體照護品質。

關鍵字

肺癌；標靶治療；不確定感

並列摘要

This article describes a patient with lung cancer not effectively controlled by chemotherapy, which caused the patient to experience both physical and mental stress from the unpredictable recovery and the side effect of diarrhea from the target drug. The patient continued to show negative emotions and behaviors. From March 28 to April 30, 2018, while caring for the patient, the author used the Roy's Adaptation Model Theory as the framework, which identified the change in bowel movement and detected in patient the sense of uncertainty and hopelessness for health. In addition to providing care through listening and companionship, author built a supportive trust relationship with the patient to understand the psychological need. Besides guiding the patient to share his feelings, author also provided adequate knowledge and clarification in terms of lung cancer treatment. The side effect of diarrhea, as well as skin care and other physiological discomforts, was treated by consulting with other clinical experts, so that the sense of uncertainty from physical and mental stress could be alleviated. Moreover, with the help of religious consultation and life reflections which focus on good things in life, the patient was encouraged to share the inner doubts and participate in treatments, allowing the patient to truly feel at ease to cherish the opportunity of treatment. The patient regained the meaning and hope for life to embrace the present and the future. By sharing this nursing experience, we hope the colleagues can use this as a reference to better understand the overall patient condition and improve the quality of care for patients in similar needs.

並列關鍵字

Lung cancer ； Target therapy ； Uncertainty

參考文獻

朱怡瑾、劉曼盈、胡嘉桂、蘇家慧、陳姿蓉、陳俏潓、吳麗敏（2018）．不確定感之概念分析．高雄護理雜誌，35（2），53-60。https://doi.org/10.6692/KJN.201808_35(2).0005

林筱青、許晉豪、張簡志炫、楊正三（2016）．不同的皮膚照護方案對成人失禁性皮膚炎之改善成效：系統性文獻回顧．南臺灣醫學雜誌，12（2），103-114。https://doi.org/10.6726/MJST.201612_12(2).0007

柯獻欽、鄭高珍（2018）．晚期非小細胞肺癌之化學治療與標靶治療．內科學誌，29（3），143-152。https://doi.org/10.6314/JIMT.201806_29(3).04

陳彥汝、陳淑卿、賴裕和、李芸湘（2015）．應用自我調節模式於癌症病人害怕復發之處置．台灣醫學，19（1），91-98。https://doi.org/10.6320/FJM.2015.19(1).13

趙可式（2015）．安寧療護是普世價值且為護理的本質．護理雜誌，62（2），5-12。https://doi.org/10.6224/JN.62.2.5

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照護一位肺癌病人對標靶治療產生不確定感之護理經驗

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