- 期刊
以安寧療護理念協助一位膽管癌末期病人善終之護理經驗
Nursing Experience to Provide Palliative Care for a Terminal Patient Suffering from Cholangiocarcinoma
摘要
本文描寫一名膽管癌末期女性與其家屬面臨死亡之護理經驗，其罹病期間經歷了先生病逝的哀傷，後因自身疾病惡化，面臨年幼子女後續照顧問題，承受生理、心理、社會、靈性各方面的苦難。護理期間為民國104年4月18日至8月28日，藉由觀察、身體評估、會談以及查閱病歷之方式蒐集相關資料，評估個案有疼痛、不確定感、靈性困擾及重要他人的哀傷與悲慟之護理問題，結合安寧共同照護團隊，分別以藥物及非藥物之方式作為護理措施，並運用傾聽、同理等會談技巧、生命回顧、唸讀繪本、藝術治療等方式，協助病人及其家人面對死亡，進一步道愛、道謝、道歉、道別，於病人往生後持續追蹤年幼子女調適情形，陪伴經歷喪親之哀傷。此案例護理過程說明了於非安寧專科病房之末期照護能力有提升的需要，並且顯示適時轉介及良好病情告知的重要，以達到死者善終、生者正向面對未來的理想狀態，期望此照護經驗能供日後類似個案護理之參考。
並列摘要
The article describes the nursing care experience of an end-stage cancer woman and her family facing the lost in an acute care unit. During the treatment period, her husband died from cancer. This time, she suffered from disease progression, and faced to the issue about how to rearing her children. The patient bored the physical, psychological, social and spiritual distress. During April 18 to August 28, 2015, associated information was collected by observation, physical assessment, conversation, and chart reviewing. The main nursing problems were pain, uncertainty, spiritual disturbance, and the grief of her family members. We consulted the palliative care team, to provide appropriate interventions to the patient and her family. In addition to the physical care, we provided several ways to help them undergoing the separation, like listening, giving compassion, reading picture books, reviewing their life. They expressed love and gratitude, made apologies and faced the separation peacefully via professional care. We kept caring about the emotion and behaviors of the children, and arranged art therapies throughout their bereavement for 3 months after the patient passed away. Through this case, we found that the sensitivity of clinical nurses and immediate interventions were critical in the whole caring process for patients in oncology wards. No doubt that previous training courses for professionals in end of life care, the timing of referral immediately, and appropriate truth-telling were the key elements to help the patients achieving good death, and their family building positive connection to the deceased.