協助一位喉癌病患做醫療決定之照護經驗

Assisting a Patient with Laryngeal Cancer in Medical Decision Making

林秀香(Hsiu-Hsiang Lin)

《源遠護理》 8卷1期 (2014/04) Pp. 72-78

https://doi.org/10.6530/YYN.2014.8(1).10

摘要

本文為協助一位喉癌病患於住院過程做醫療決定之照護經驗。藉由探討個案對醫療決定的害怕、焦慮、不確定感而無法做醫療決定，使得病情延誤導致病情生命受威脅。筆者於2011年12月14日至2012年02月22日照護期間，運用身體評估、觀察、會談進行整體性護理評估，歸納出個案有呼吸道清除功能失效、無法做醫療決定、手術後身體心像紊亂之護理問題。護理過程中筆者教導個案運用有效咳嗽能力，必要時給予抽痰以維持呼吸道通暢。建立護病關係的信任度、協助適當的壓力釋放、鼓勵個案參與醫療決定，協助個案做出符合最大利益的醫療決定。在術後適時給予心理支持，教導個案自我照顧氣管造口，並給予正向鼓勵和稱讚，鼓勵家屬能瞭解個案身體心像紊亂的反應並陪伴順利渡過。希望透過此照護經驗分享，臨床上發現病患無法獨立做出醫療決定時，適時介入扮演代理決策人，鼓勵病患參與醫療決定，方能提供最大利益醫療決定。

關鍵字

喉癌 ； 全喉切除 ； 做醫療決定

並列摘要

This article describes the 10-week nursing care of a patient with laryngeal cancer from decision making of treatment process to post-surgery care. The patient's fear, anxiety and uncertainty about the treatment outcome delayed his decision making, which led to a life-threatening situation. The patient's major health problems included ineffective airway clearance, inability to make medical treatment decisions, . Nursing interventions included establishment of a trusting relationship, encouraged patient participation in treatment decision making, patient teaching on effective cough, use of suction machine to maintain a patent airway, and assisted the patient to appropriately release his emotional pressure. Post-surgery care provided physical and psychological support, patient teaching on the care of tracheostomy, helped the family to understand patient's reactions to appearance change post-surgery, and encouraged psychological support from the family. When the patient's ability for independent decision making is challenged, nurses play an importance role to help the patient to participate in own decision for treatment.

並列關鍵字

laryngeal cancer ； total laryngectomy ； medical decision making