陪伴一位癌症患者因腫瘤出血經歷死亡焦慮之護理經驗

Accompanying an Oral Cancer Patient with Tumor Bleeding to Face Death Anxiety

王謹熏(Chin-Hsun Wang) ； 游馥蓮(Fu-Lien Yu)

《腫瘤護理雜誌》 21卷增訂刊II (2021/12) Pp. 83-94

https://doi.org/10.6880/TJON.202112/SP_21.07

摘要

本文描述一位口腔癌癌末病人，因惡性腫瘤傷口引發非預期性大出血最後疾病進展惡化瀕死之護理經驗。筆者在2019年1月11日至2019年1月14日照護期間，運用羅氏適應模式評估，採觀察、筆談、身體檢查評估及與家屬會談收集與分析資料，確立個案有「組織完整性受損導致腫瘤出血」、「因應能力失常」及「死亡焦慮」健康問題。針對組織完整性受損導致腫瘤出血給予傷口換藥、腫瘤出血護理及心理支持，減輕腫瘤大量出血產生的焦慮不安，藉由提供合適敷料減輕傷口換藥不適及出血風險，緩解其生理不適、心理焦慮；同理個案想說卻無法表達的無奈，利用紙卡及筆談工具發展默契式互動，增進護病信任關係，以減低個案的焦慮，由筆者與團隊引導，讓個案與家屬互相進行道謝、道愛、道歉、道別，使個案得以回顧一生，回憶過往快樂時光，協助宣洩此生中哀傷或痛苦並讓家屬進行病人一生功德回饋，使個案與家屬得以正向面對疾病進展及死亡，透過安寧共同照護預備遺族輔導，讓個案於生命的最終時刻能達到尊嚴辭世，最終讓個案身、心、靈等需求獲得滿足。藉由此個案照顧經驗分享，可作為未來護理同仁照護口腔癌末期出血個案及其家屬之參考，期望能協助個案能在有限的生命中，維持尊嚴及生活品質並達善終。

關鍵字

癌症 ； 腫瘤出血 ； 死亡恐懼

並列摘要

This article describes the nursing experience of a terminal patient with oral cancer, who was suffering from unanticipated hemorrhage caused by a malignant tumor wound, which eventually progressed and deteriorated. During the nursing period from January 11 to January 14 of 2019, the author used Roche's adaptation model assessment, collected and analyzed data through observation, written interviews, physical examination and assessment, and interviews with family members to identify the patient's health related problems, which were ＂impaired tissue integrity related tumor bleeding＂, ＂dysfunctional coping ability＂ and ＂death anxiety＂. Regarding the damage of tissue integrity and the resulted tumor hemorrhage, we provided wound dressing, tumor hemorrhage care and psychological support to reduce anxiety caused by massive tumor hemorrhage; we also provided approapriate dressings to reduce the discomfort of wound dressing and bleeding risk, and alleviated physical and psychological anxiety; on a different front for the helplessness that the patient felt when he couldn't express at will, we showed him the use of flash cards and written conversation tools to develop tacit interactions, enhance the trust relationship between nurses and patients, and reduce the anxiety of the patient. The author and the team guided the patient and family members to show love and appreciation for one another, to apologize and say goodbye so that the patient can look back on life, recall the happy times in the past, express the sorrow or pain in this life, and let the family members acknowledge the patient's lifelong merits, so that the patient and family members can face the disease progression and death in a mindful way through tranquility, joint care, and preparedness of the bereaved family counseling, so that the patient could pass away with dignity at the final moment of life, and satisfied the patient's wish for the body, mind, and spirit. The sharing of this patient care experience can be used as a reference for future nursing colleagues in caring for the end-stage oral cancer bleeding patients and their family members. It is also hoped that this article can help patients to maintain dignity and quality of life in the limited final days and achieve the goal of hospice.

並列關鍵字

cancer ； tumor bleeding ； fear of death

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