運用靈性互動模式於一位乳癌末期病人之護理經驗

本篇個案報告是探討一位乳癌末期病人面臨靈性困擾之護理經驗，筆者於照護期間2019年7月12日至2019年8月14日，經由病歷查閱、觀察、會談、直接護理的方式進行資料收集，依Gordon功能性健康型態確立個案主要護理問題為靈性困擾、潛在危險性感染、低效性呼吸型態和疲憊。由於靈性安適是整體健康的要素，因此筆者進一步運用Stoll（1989）靈性互動模式，分析個案與環境間的關係達到融合，但個案與自我、與他人、與至高者的關係則出現分裂。在護理過程中，筆者秉持真誠、同理與主動關懷的精神，在醫療團隊、家屬、摯友的合作下，透過生命回顧幫助個案對生命與受苦難做重新的詮釋，引導個案表達內心感受、對死亡的看法及需求，使其能坦然接受死亡的事實，做好臨終的準備，獲得靈性上的安適。期望透過此護理經驗的分享，能讓護理人員在照顧癌末病人時能提供更多的幫助。建議臨床教育上能舉辦更多靈性照護的實務技巧教學，以提升護理人員靈性照護的應用。

關鍵字

靈性照護；癌症末期；靈性困擾

並列摘要

This case report discusses the nursing experience of caring for a patient with end-stage breast cancer who was facing spiritual distress. During the nursing period from July 12, 2019 to August 14, 2019, and through review of medical records, observation, interviews and direct nursing to collected data. According to Gordon's functional health types, there were four main nursing problems involved in this case, including spiritual distress, dangerous infection, ineffective breathing pattern and fatigue. Because spiritual well-being is an element of overall health, the author uses Stoll's (1989) the person's spiritual interrelatedness to analyze the relationship between the case and the environment to achieve integration, but the relationship between the case and the self, with others, and the Supreme One is split. Due to the limitation of the number of pages, and this article mainly focuses on the nursing problems of spiritual distress. Upholding the essence of sincerity, empathy and active care, together with the cooperation of the medical team, family members and close friends, the author helped the patient reinterpret life and suffering through the life review method that guided the patient to express her inner feelings, views on death, and her needs. This enabled the patient to accept the certainty of death calmly, prepare for it, and obtain spiritual comfort. By sharing this particular nursing experience, hopefully other nursing staff will be able to provide more help in caring for patients with end-stage cancer. It is recommended that more practical skills concerning the teaching of spiritual care can be included in clinical education to enhance the application of spiritual care by nursing staff.

並列關鍵字

spiritual care ； end-stage cancer ； spiritual distress

參考文獻

King, S. D., Fitchett, G., Murphy, P. E., Pargament, K. I., Harrison, D. A., & Loggers, E. T. (2017). Determining best methods to screen for religious/spiritual distress. Supportive Care in Cancer, 25(2), 471-479. https://doi.org/10.1007/s00520-016-3425-6

Yaghoobzadeh, A., Soleimani, M. A., Allen, K. A., Chan, Y. H., & Herth, K. A. (2018). Relationship between spiritual well-being and hope in patients with cardiovascular disease. Journal of Religion and Health, 57(3), 938-950. https://doi.org/10.1007/s10943-017-0467-0

劉芊葳、楊婉萍（2017）．運用同理心溝通技巧提供年輕癌末病人靈性照護．安寧療護雜誌，22（2），213-227。

Google Scholar

梁珮芸、吳律嫺、蘇淑女（2017）．照顧一位因肝惡性血管內皮瘤接受活體肝臟移植術後之護理經驗．彰化護理，24（4），35-47。

Google Scholar

楊蓉甄、林淑媛（2017）．活體肝臟移植病人不確定感之照護經驗．高雄護理雜誌，34（3），128-137。

Google Scholar

主題瀏覽