一位年輕血癌末期病人之安寧共同照護經驗

Nursing-Care Experience of Hospice Shared Care to a Young Adult Patient with Acute Lymphoblastic Leukemia during Terminal Stage

謝慧貞(Hui-Jen Hsieh) ； 陳瑞儀(Jui-Yi Chen)

《安寧療護雜誌》 24卷2期 (2020/06) Pp. 164-175

https://doi.org/10.6537/TJHPC.202006_24(2).06

摘要

癌末病人因治療的副作用、不確定感及死亡恐懼，承受身、心、靈痛苦，身旁摯愛的家人也同受心理、靈性困擾。本文為一位年輕血癌末期個案接受非親屬異體周邊幹細胞移植後病情持續進展，引起生理、心理及靈性困擾之護理經驗。筆者以安寧共同照護護理師角色，藉由觀察、身體評估、會談及團隊溝通進行生理、心理、靈性及社會評估，確認個案有「呼吸困難」、「醫療抉擇困難」、「預期性哀傷」護理問題。以共同照護模式協助病情溝通、協調，提供症狀緩解用藥建議；使用輔助療法緩解呼吸困難的不安與恐懼；提供陪伴、支持、傾聽，引導病人與家屬表達內心感受與需求，釐清末期醫療照護目標與方向；最後協助個案與家人面對死亡，得以生、死兩相安。

關鍵字

安寧共同照護 ； 血癌末期 ； 呼吸困難 ； 醫療抉擇困難 ； 預期性哀傷

並列摘要

Due to uncertainty in the treatment process and fear of death, patients with terminal cancer suffer from physical, psychological, and spiritual problems. The same is true of their family members. This article describes the nursing experiences of a young patient with advanced cancer and his families who are facing disease progression and suffering from many physical, psychological, and spiritual problems. The researchers gathered relevant information by clinical observations, physical assessment, consultation during the work of hospice shared care in the hematology ward. The patient's main nursing problems were dyspnea, difficulty in making decisions, and anticipatory grief. To solve the issues, the researchers discussed symptom management and care goals with the patient and his families. Through the hospice shared care process, we provided adjuvant therapy to alleviate respiratory distress, anxiety, and fear. In addition, we helped them to express their inner thoughts and needs by actively listening, supporting, and accompanying them. In the end, the patient died peacefully, and the families also obtained bereavement by establishing a positive connection with him and fulfilled patients ＂life mission＂.

並列關鍵字

Hospice shared care ； terminal acute lymphoblastic leukemia ； dyspnea ； medical decision making ； anticipatory grief

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