結合安寧共同照護一位食道癌末期病人護理經驗

本文描述一位食道癌末期中年男性，因面對疾病無法治癒，對未來感到無望，同時表達出想返家的心願，故引發筆者探討動機，護理期間為2019年5月9日至6月1日，運用Gordon十一項功能性健康型態，以觀察、會談、翻閱病歷、身體評估及家庭會議等收集方式，發現個案有慢性疼痛、無望感及增進家庭因應能力的準備度等健康問題。透過原醫療團隊與安寧團隊共同合作，經由詳細的疼痛評估，調整止痛藥物及給予音樂治療、精油按摩與舒適臥位，以減輕疼痛；藉由傾聽及關懷陪伴，引導說出心中感受及期許，運用生命回顧及家庭支持力量，幫助個案完成暖親圓夢、表達對家人的愛，重拾生命意義及存在價值，進而增進希望感；透過家庭會議了解家庭處遇與照顧需求，利用視訊評估居家環境，共同研擬居家靜脈營養輸液學習計畫，並錄製教學影片、製作指導手冊及回覆示教確認執行正確性，最後讓個案如願返家，出院後持續電訪追蹤，並安排安寧居家護理師接續照護，使其獲得持續且完整的照護。

關鍵字

食道癌；末期疾病；安寧共同照護；居家靜脈營養

並列摘要

This article demonstrates a nursing experience through hospice combined with palliative care for a middle-aged man with terminal esophageal cancer to fulfill his wish to return home. This patient faced an incurable disease and suffered from physical discomfort and hopelessness of life, so he expressed a strong wish to go home rather than staying in the hospital. The above situation triggered the author's motivation to explore the patient's nursing care. The nursing period was from May 9th, 2019 to June 1st, 2019. The Gordon's functional health model was used for the assessment of this patient. The data were collected through observation, consultation, physical examination, chart reviews, and family meetings. The issues identified were pain, sense of hopelessness, and the need to prepare for enhanced family coping. We provided a detailed pain assessment by the original medical team and hospice team, after which we adjusted the pain medications and gave him music therapy and essential oil massage while showing him on how to maintain a comfortable position to reduce the pain. Furthermore, we encouraged the patient to express his feelings and expectations through active listening. We also guided him to fulfill his wishes through family support and life review. We encouraged family members and the patient to express their feelings about life, to approve the meaning of life, and to regain hope of life. We clarified their family needs and care needs through family meetings. We used web camera to assess his home environment and made tailored training plan for home parenteral nutrition execution, which included demonstration videos, instructional manuals and repeated live demonstrations, practice and feedback to reach perfection. At the end, the patient was discharged and went home smoothly. We conducted telephone interviews and arranged home caregiver to monitor the process of home parenteral nutrition and to provide continuous and complete medical care.

並列關鍵字

esophageal cancer ； terminal disease ； hospice and palliative care ； home parenteral nutrition

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