運用安寧療護理念於胃癌末期病人之照護經驗

本文描述運用安寧療護理念照顧一位58歲胃癌末期病人的護理經驗。於2012年11月2日至11月28日照護期間，針對個案身心靈、社會層面做整體性評估，藉由直接照護、會談、觀察及病歷查閱方法收集資料，確立個案有「因腹部腫塊阻塞引起得噁心、嘔吐及口乾」、「因腹部腫塊阻塞引起雙下及陰囊水腫」、「對案妻的愧疚，期待被寬恕」及「面對個案病情直轉急下瀕臨死亡，家人情感的衝擊－不捨與善終」護理問題。照護過程中，運用安寧療護理念，經由傾聽、主動關懷、同理及支持陪伴和同在方式，協助個案改善身體噁心、嘔吐及水腫症狀；傾聽個案的愧疚，做個案和案妻溝通的橋樑，協助個案向案妻表達內心虧欠；協助家屬面對個案病情直轉急下瀕臨死亡之際，能充分地和個案道愛、道別及情感的凝聚與善終心願完成，使個案身心靈能獲得安適，達到平安善終。

關鍵字

安寧療護；癌末；善終

並列摘要

This article describes the experience of applying hospice and palliative care principles in caring a 58-year old patient with advanced gastric cancer. During the period between 2^(nd) and 28^(th) November 2012, this patient also received a comprehensive assessment to identify his physical, spiritual and social status. Data collection approaches consisted of direct care, conversation, observation and medical chart review. The problems associated with this patient care included nausea, vomiting, dry mouth, bilateral lower extremities and scrotum edema related to obstructive abdominal tumor, guilty feeling about being ill and wishing to be forgiven, disease progressed rapidly, emotional stress and shock of the dying patient and his family- as well as spiritual issues related to abnegation and hospice. Palliative care principles were applied to the patient during the period of hospice care. Through active listening and care, empathy, support and company, patient obtained the symptomatic relief of nausea, vomiting and edema. The caregivers also listened to his confession, acted as communicators between the patient and his wife, and assisted him to make apology to his wife. His family was encouraged to express love to him while he was facing death because of a rapid progression of disease. His wishes in gathering family's love and peaceful dying were fulfilled. The patient finally met the needs of physical and spiritual comfort and achieved a peaceful death.

並列關鍵字

hospice palliative care ； advanced cancer ； peaceful death

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運用安寧療護理念於胃癌末期病人之照護經驗

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