協助肝硬化末期病人在宅善終之護理經驗

Hospice Nursing Care Experience for A Terminal Cirrhosis Patient to Die at Home

戴素絹(Su-Chuan Tai) ； 余惠娟(Heui-Chuan Yu)

《安寧療護雜誌》 24卷1期 (2020/03) Pp. 72-82

https://doi.org/10.6537/TJHPC.202003_24(1).06

摘要

本文係照護一位肝硬化末期病人，因反覆入院、疾病的症狀及治療所帶來的不適，轉入安寧病房，多數家屬顧慮末期病人病情變化多端，不敢讓病人在宅善終，引發撰寫動機。護理期間於2016年1月15日至2月15日，藉由溝通、觀察會談、身體評估等方式蒐集病人生理、心理、社會及靈性資料，確立病人有傷口感染、體液容積過量、擔心無法在宅善終、家屬預期性哀傷等問題。運用安寧照護理念與文獻擬定護理計畫，讓病人獲得身體舒適、病人與家屬對於臨終地點有共識、引導家屬如何抒發哀傷情緒；提供安寧居家照護，教導家屬舒適照護技巧和協助後續照顧問題，從醫院延伸到居家，滿足病人身心靈需求，完成病人在宅善終心願。最終病人出院後10天平安往生。筆者期待藉此在宅善終經驗的分享能作為協助生命末期病人返家計畫之參考。

關鍵字

因應肝硬化末期 ； 安寧療護 ； 在宅善終

並列摘要

This article is a case study of an end-stage cirrhosis patient. Due to disease burden, repeated hospitalization, and discomfort related to treatments, the patient was transferred to the hospice ward. At the end stage of cirrhosis, patient and his families are facing the problem of death and bereavement. However, most family members worry about the challenges of terminal conditions, and thus are afraid of letting the patient pass away at home. The fact that most patients died in cold hospital beds with many wishes unfulfilled, prompted the author to write this article. During the nursing period from January 15th to February 15th, 2016, the author collected physical, psychological, social and spiritual data about the patient and the family through communication, observation and physical assessment. The author observed that the patient had: infections, excessive body fluid, death fear, and the patient's family has grief anticipation and other issues. The author applied concept of hospice care from literature and developed a care plan to help the patient to be physically comfortable, to have consensus with family members on the dying location; guiding the family to express sadness, and teaching the family with comforting and care skills. The author assisted with hospice and follow-up care issues, extending hospice care from the hospital to the home in order to meet the patient's physical and mental needs, and helped fulfilling the patient's wish of dying at home. The author hopes that our experience can be used as a reference for the home care planning for such end-of-life cases.

並列關鍵字

terminal cirrhosis ； palliative care ； hospice home care

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