運用安寧療護理念於一位肝內膽管癌合併多處轉移病人無望感之照護經驗

Nursing Care Experience of a Patient with Intrahepatic Cholangiocarcinoma with Multiple Metastases and Helplessness Using the Concept of Palliative care

黃婷萱(Ting-Hsuan Huang) ； 陳怡燐(Yi-Lin Chen)

《嘉基護理》 22卷2期 (2022/12) Pp. 36-46

摘要

本文描述一位肝內膽管癌合併多處轉移病人無望感之照護經驗，護理期間自2020年12月21日至12月28日，運用觀察、會談以及查閱病歷來收集相關資料，並運用生理、心理、社會與靈性四大層面來進行整體性的護理評估，確立個案有疼痛、預期性哀傷、無望感三項護理問題。疼痛部份，給予舒適擺位、精油按摩來緩解疼痛不適；預期性哀傷部份，運用同理、不批判的態度，引導個案及照顧者訴說出內心感受及接受死亡來臨；無望感方面，藉由宗教信仰，減輕內心不安及恐懼，在醫護人員的同理及鼓勵下使個案表達出內心感受，並展現真誠、接納及尊重，陪病人度過哀傷的各個階段，在安寧團隊下給予心靈關懷，讓個案接受死亡的過程及引導個案對身邊的親友道愛、道歉、道謝、道別。

關鍵字

肝內膽管癌 ； 無望感

並列摘要

This report describes the care experience for a helplessness of patients with intrahepatic cholangiocarcinoma and multiple metastases. During the nursing period lasted from December 21 to December 28, 2020, data were collected via observations, interviews, and medical record for a holistic assessment based on the physiological, psychological, social, and spiritual aspects of the patient. The results revealed that the patient had three health problems such as pain, anticipatory grief, and helplessness. In terms of pain, comfortable positioning and massage using essential oil were administered to alleviate pain and discomfort; in terms of anticipatory grief, an empathetic and non-critical attitude was adopted to guide the case and caregiver to speak about their inner feelings and accept death; in terms of hopelessness, the case restlessness and fear were reduced through religious beliefs. Under the empathy and encouragement of the medical and nursing staff, the case expressed his inner feelings. Sincerity, acceptance, and respect were also demonstrated, accompanying the patient through the various stages of grief. The hospice team provided spiritual help so the case accepted the process of dying, and to guide patient and his family express their love, apology, thanks and farewell to one another.

並列關鍵字

intrahepatic cholangiocarcinoma ； hopelessness

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