- 期刊
運用關懷理論照顧一位乳癌復發多處轉移合併肋膜積液病人的護理經驗
Nursing Experience of Applying Swanson Caring Theory to a Patient with Breast Cancer Recurrence, Multiple Metastases and Pleural Effusion
摘要
本文運用Swanson關懷理論於一位44歲乳癌復發多處轉移合併肋膜積液病人的照護經驗，於2019年7月24日至2019年8月6日照護期間，透過觀察、會談、身體評估及查閱病歷資料等方式，針對生理、心理、社會、靈性進行整體性評估，歸納出個案有低效性呼吸型態、疼痛、哀傷之護理問題。筆者針對個案出現之護理問題，提供個別性之照護：生理方面針對個案肋膜積液，協助胸腔放液，使肺部有足夠表面積實施氣體交換，並指導個案採端坐呼吸及噘嘴式呼吸，緩解呼吸喘及咳嗽情形；針對疼痛問題，定時探視個案觀察其疼痛情形，並按時給予適量止痛藥物，減低疼痛不適，同時鼓勵個案多聽音樂或是與家屬、友人聊天轉移注意力，使疼痛問題得以改善；哀傷問題方面，在照護期間筆者曾多次觀察到個案因身體疼痛不適落淚，以及對於自己生命晚期接受度較低，家屬情緒也較低落，曾因照護想法不同而有爭執，故透過心理師、安寧共照師的協助，提供個案及照顧者所需，並鼓勵個案進行未來規劃，解決其哀傷的問題。藉由此次照護經驗體會到病人心理困擾，建議臨床護理人員在照顧此類病人時，除了著重於緩解生理不適外，亦須加強心靈層面的照護。期望透過此篇個案報告，分享個案個別性護理照護經驗。
並列摘要
This article explored the nursing experience of a 44-year-old patient with breast cancer recurrence, lung, liver and bone metastases, and pleural effusion between July 24 and August 6, 2019. The comprehensive assessment included physical, psychological, social and spiritual dimensions through observation, interviews, physical exam and medical record review. The patient's nursing problems were ineffective breathing pattern, pain, and grief. The authors provided individualized direct care for the patient. Physical care included helping the patient to have sufficient gas exchange during pleural drainage procedure. Taught the patient to take a sitting position and practice pursed-lip breathing during dyspnea and coughing episodes. The nurses conducted regular pain assessment, provided analgesia based on pain severity, and encouraged the patient to use distraction such as music or chat with family members. The patient cried often from her physical discomfort and sadness. Family members were also under stress over different caring issues. The care team incorporated a psychologist and a hospice-shared-care nurse to address patient and her family members' needs, and encouraged the patient make plans for the future. We learned that the clinical nurses need to not only relieve the patient's physical discomfort, but also care for her psychological and spiritual pain.
參考文獻
延伸閱讀
- 謝育儒、鄭惠蘭（2022）。照護一位乳癌合併蕈狀傷口個案之照護經驗。腫瘤護理雜誌，22(1)，99-111。https://doi.org/10.6880/TJON.202206_22(1).08
- 陳清萍、王玉女（2022）。運用品質關懷模式照顧一位接受乳癌切除手術個案之門診護理經驗。長庚科技學刊，(36)，105-116。https://doi.org/10.6192/CGUST.202206_(36).10
- 林誼婷、劉惠瑚、賴慧貞（2021）。一位乳癌短期內復發轉移病人之個案管理照護經驗。醫學與健康期刊，10(2)，103-115。https://www.airitilibrary.com/Article/Detail?DocID=23046856-202107-202108160009-202108160009-103-115
- 王鈞渝、孫嘉慧、李榮真（2022）。Nursing Experience of Applying Swanson's Caring Theory to a Patient With Peritoneal Dialysis Peritonitis and Acute Ileus。馬偕護理雜誌，16(1)，24-34。https://doi.org/10.29415/JMKN.202201_16(1).0003
- 王甄薇、古雪貞、張美靜（2015）。The Nursing Experience of Caring for a Patient with End-Stage Ovarian Cancer Secondary with Severe Pleural Effusion。馬偕護理雜誌，9(2)，90-101。https://doi.org/10.29415/JMKN.201507_9(2).0008