一位末期子宮頸癌病人及家屬面對死亡哀傷歷程之照護經驗

The Nursing Experience of Advanced Cervical Cancer Patient and Her Family Suffering from Anticipatory Grief

張孔齡(Kong-Ling Chang) ； 張詩吟(Shin-Yin Chang)

《安寧療護雜誌》 23卷1期 (2018/03) Pp. 58-69

https://doi.org/10.6537/TJHPC.201803_23(1).05

摘要

本文在敘述照護一位末期子宮頸癌瀕死的病人，及病人家屬在面對疾病臨終階段而出現哀傷之護理經驗，照護期間自2015年11月28日至2016年1月2日止，筆者運用臨床照護、觀察及與家屬會談方式收集資料，並以Gordon十一項健康型態評估進行分析統整，確立主要健康問題：癌症疼痛、高危險性感染及家屬預期性哀傷。針對問題進行文獻搜尋並提供個別性的護理措施，運用集中護理、舒適擺位技巧、精油按摩及止痛藥物的使用，以減緩因疾病進展衍生的疼痛問題，而感染導致之發燒給予藥物使用外，也提供溫水拭浴及維持身體皮膚之舒適護理，另以同理及尊重的態度與家屬建立信任關係，提供悲傷陪伴，協助家屬緩解生、心、靈的不安及善終準備，達到安寧的照護理念，希望藉由分享此照護經驗，提供未來照護類似病人之參考。

關鍵字

末期病人感染照護 ； 癌症疼痛 ； 預期性哀傷 ； 安寧療護

並列摘要

The purpose of this case report is to share the nursing experience of a terminal cervical cancer patient and her family experienced anticipatory grief at the end of life stage. The period of nursing care was from November 28, 2015 to January 2, 2016. The author used the Gordon's 11 functional health patterns assessment tool to detect patient’s nursing problem through the medical records reviewing, empathic communication and observation skill to collect data. The following nursing problems were pain, high risk of infection and anticipatory Grief. The author provide an individualized intervention plan include intensive care, comfort care, essential oil massage, pain management and music therapy to alleviate cancer pain and the other discomfort symptoms. Have a deep communication with patient and family to discuss about time-limited trial in antibiotic using for repeated infection to avoid futile medical care. The author accompanies the dying on her final journey, helping patient and family to achieve the good-death. The author expects that this care experience can serve as a reference for those caring for patients in similar cases.

並列關鍵字

infection control at the end of life ； cancer pain ； anticipatory grief ； palliative care

參考文獻

1. 行政院衛生福利部國民健康署。2016 年主要死因統計結果分析。臺北:衛生署,2017。

2. 黃馨葆。癌症疼痛控制－減少病人難以承受的苦。彰基院訊 2013;30 (1): 24-5 •

3. 胡文郁、陳宛榆、羅淑芬、陳書毓、黃翰心、陳幼貴。成人癌症疼痛臨床照護指引。腫瘤護理雜誌 2011;11(3): 87-127 •

4. 李雅萍、黃馨葆、蔡兆勳、陳慶餘、邱泰源。癌症疼痛控制的現況。安寧療護雜誌 2012;17(1):62-75。

5. 許喬琳、潘湘如。安寧療護使用抗生素的倫理考量:以接受腰大肌膿瘍治療病人爲例。安寧療護雜誌 2015;20(2): 177-85 •