心慟不捨中放手祝福：一位末期肺癌病人之家屬預期性哀傷撫慰

Nursing Care for Anticipatory Grief of the Caregiver of a Terminal Lung Cancer Patient- A Case Study

陳月蓉(Yueh-Jung Chen) ； 王雅芳(Ya-Fung Wang) ； 郭淑華(Shu-Hua Kuo) ； 楊婉萍(Wan-Ping Yang)

《安寧療護雜誌》 20卷1期 (2015/03) Pp. 79-87

https://doi.org/10.6537/TJHPC.2015.20(1).7

摘要

本照護經驗將安寧療護四全照護的精神-全人、全家、全程與全隊理念(1)，從病人照護擴及到高危險哀傷家屬之預期性哀傷撫慰。分享一位誤判病危返家往生卻存活下來的末期肺癌病人，提供其高危險性哀傷的案妻預期性哀傷撫慰，化危機為轉機，並陪伴其走過急性哀傷期，追蹤後續反應之哀傷撫慰照護經驗。以行為過程實錄方式，記錄接受安寧居家照護期間：2012年6月至2013年1月，家訪45次，病人往生後進行遺族關懷2次的護理照顧過程，繕寫照護團隊與病人及家屬之互動及對話，經內容分析整理而成。在照護過程中，藉家庭樹與家庭動態評估來篩選出高危險性哀傷者，為其量身打照適切的哀傷撫慰策略，並不斷省思修正。希冀以此作為日後健康照護團隊提供家屬哀傷撫慰之參考。

關鍵字

失落 ； 哀傷 ； 預期性哀傷 ； 喪親 ； 安寧療護

並列摘要

Four core values of hospice care, whole person, whole family, whole process, and whole team, were applied to patient care during this nursing process. Anticipatory grief care was provided to high-risk grieving family member. The wife of a terminally ill lung cancer patient, who was wrongly diagnosed as being near death yet in fact survived after returning home to pass away, was provided with anticipatory grief care, thus turning crisis into opportunity. The nurse went through the stages of acute grief with the wife and did a follow-up on her reaction to the experience with the bereavement care. Process recording was used to record the period during which hospice care was provided at home. From June 2012 to January 2013, home visits were executed 45 times and bereavement care was provided twice after the patient passed away. The interactions and conversations between the caregiving team and the patient and his family members were recorded; these notes were then further analyzed and compiled. Family tree and family dynamics were evaluated to screen the high-risk care-grievers. And individual bereavement care strategies were plan by health care team for them. Constant revisions were made to the strategy in hopes of serving as a reference for future health care teams when providing anticipatory grief care and bereavement care to family members.

並列關鍵字

loss ； grief ； anticipatory grief ； bereavement ； hospice palliative care

參考文獻

Kissane, D.W., & Block, S. (1994). Family grief. British Journal of Psychiatry, 164, 728-740. doi: 10.1192/bjp.164.6.728

趙可式（2007）．安寧伴行．台北：天下遠見。[Chao, C. S. (2007). Stay with palliative care. Taipei City, Taiwan, ROC: Global Views Publisher.]

Jacob, S. R. (1993). An analysis of the concept of grief. Journal of Advanced Nursing, 18, 1787-1794.

Rando, T.A. (1984). Grief, Dying and Death: Clinical Interventions for Caregivers. Champaign, IL: Research Press Company.

Worden, J. W. (1991). Grief Counseling and Grief Therapy: A Handbook Mental Health Practitioner. New York: Springer.