提供安寧療護於一位肺癌末期病人之護理經驗

Hospice Palliative Care of a Patient with Advanced Lung Cancer

葉昱辰(Yu-Chen Yeh) ； 鄭如芬(Ju-Fen Cheng) ； 鍾玉珠(Yu-Chu Chung) ； 林雅卿(Ya-Ching Lin) ； 張慧蘭(Huei-Lan Chang)

《源遠護理》 8卷1期 (2014/04) Pp. 63-71

https://doi.org/10.6530/YYN.2014.8(1).09

摘要

本文旨在敘述提供安寧療護於一位肺癌末期病人於住院期間面對生理不適、心理衝擊及靈性困擾等問題之護理經驗。護理期間自2011年10月14日至2011年11月7日，以個案為中心，透過觀察、會談、身體評估及病歷查閱等方式收集資料，進行身體、心理、社會及靈性評估，確立個案的主要護理問題有低效性呼吸型態、急性疼痛、哀傷及心靈困擾。護理過程運用安寧療護的「四全」理念，主動提供個別性、及時性之護理措施，以緩解呼吸困難及疼痛感，增進個案身體舒適；藉由陪伴和傾聽以了解個案在疾病過程所面臨之心理衝擊，以協助其對家人道謝、道歉、道愛、道別之過程表達愛，進而減輕哀傷過程；並運用靈性照護技巧，提供資源以滿足個案對善終的期待，使其對死亡的負面思考能轉化面對死亡的心理準備，而克服死亡帶來的威脅，護理過程以個別性護理措施協助個案獲得安寧療護所強調之身、心、靈性三方面安適，以提升癌末生活品質並有機會達成「善終」。

關鍵字

肺癌末期 ； 疼痛 ； 安寧療護 ； 護理經驗

並列摘要

This article describes the 3-week palliative care nursing experience of a hospice patient with advanced lung cancer. Patient assessment data were collected through observation, interview, physical assessment, and review of medical records, with the focus on the patient’s physical, psychological, social, and spiritual aspects. Major nursing health problems included an ineffective breathing pattern, acute pain, anticipatory grieving and spiritual distress. Nursing care interventions that were provided included symptom relief of dyspnea and pain, application of four core values of hospice palliative care to improve physical comfort, provision of companionship and active listening, and assisting the patient to express his appreciation, apology, love, and farewell to his family. Information and spiritual care were provided to meet the patient’s expectation of death. The patient was able to transform from negative thinking into positively facing the inevitable. The hospice palliative care improved the quality of life during terminal stage and gave the patient an opportunity to obtain ＂good death.＂

並列關鍵字

lung cancer ； terminal stage ； pain ； hospice palliative care