運用Swanson關懷理論照護一位甲狀腺癌末期患者之護理經驗

本文分享一位45歲男性患者罹患末期甲狀腺癌，因頻繁腹瀉影響日常活動，又面臨病情惡化出現死亡焦慮之護理經驗。筆者於2016年9月3日至9月25日照護期間以理解、觀察、直接照護、會談、及病歷查閱等方式，進行生理、心理、社會、靈性層面評估，發現個案有「腹瀉」、「死亡焦慮」、案妻的「預期性哀傷」護理問題。護理措施以Swason關懷理論為基礎，運用「了解」、「與之同在」傾聽個案需求，與個案建立良好互信關係；運用「為他做某事」、「使他能夠」策略，讓個案了解引起腹瀉原因，配合調整飲食內容；教導案妻皮膚照護方法及舒適護理技巧；連結安寧團隊資源共同照護個案，引導個案面對死亡焦慮、案妻接納預期性哀傷反應。然而個案與案妻一度抗拒安寧共照團隊，認為「接受安寧照護視同被醫療團隊遺棄」，筆者持續陪伴，傳達安寧照護理念，欣喜個案及太太出院前願意接受安寧團隊協助，在團隊與宗教師引導下藉由生活照片回顧生命故事，重新了解生命的意義，說出內心的不捨、感謝與歉意，達成「善終」且「不遺憾」的心願。此護理經驗可作為癌症末期病人照護之參考，提升癌症照護品質。

關鍵字

甲狀腺癌；腹瀉；死亡焦慮；哀傷； Swason關懷理論

並列摘要

The experience of caring for Mr. Wong, a 45-year-old male who was diagnosed terminal thyroid carcinoma from September, 2 to September, 25, 2016. Due to tumor growth causing an endocrine disorder, he suffered severe diarrhea affecting his daily activities. He also suffered from ＂death anxiety＂, and had to deal with ＂family grief＂ problem. As the parenteral nutrition specialist, I assessed his physical, psychological, social, and spiritual needs through interview, listening, observation, and direct nursing care with the patient and his family applying Swanson's caring theory. I identified 3 problems which are severe diarrhea, death anxiety and grief. I developed a trusting relationship with Mr. Wong and his family, and applied Swanson's ＂knowing＂, ＂being with＂, ＂doing for＂ and ＂enabling＂ framework. I educated Mr. Wong to the cause of his diarrhea, and the ways to adjust his diet, and taught him how to prevent bedsores. I also consulted the hospice palliative care team to help him to deal with death anxiety and help his wife to cope with the grief. In the beginning, the family refused the palliative care, worried that it may mean that the health care team gives up all his treatment. I kept educating and explaining to the family the benefits of hospice palliative care for Mr. Wong. Finally, they were willing to accept the palliative care. The palliative care team members and the spiritual counselor helped him to find the meaning of life by reviewing his life story. Mr. Wong also fulfilled his wish for ＂good death＂ and ＂no regrets＂. We hope this case report provides practical tips that the nurses can apply to improve quality in caring for terminal cancer patients.

並列關鍵字

thyroid carcinoma ； diarrhea ； death anxiety ； grief ； Swason's Theory of Caring

參考文獻

Carlson LE: Mindfulness-based interventions for coping with cancer. Ann NY Acad Sci: 2016; 1373(1): 5-12. doi: 10.1111/nyas.13029.

Zhang X, Xiao H, Chen Y: Effects of life review on mental health and well-being among cancer patients: A systematic review. Int J Nurs Stud: 2017;74:138-148. doi: 10.1016/j.ijnurstu.2017.06.012

衛生福利部：106年國人十大死因統計。 2018 年 6 月取自https://www.mohw.gov.tw/cp-3795-41794-1.html