跨團隊整合照護一位卵巢癌末期病人之護理經驗

Interprofessional Collaborative Care in an Advanced Stage of Ovarian Cancer Patient

洪映廷(Ying-Ting Hong) ； 葉月珍(Yueh-Chen Yeh)

《中科大學報》 8卷1期 (2021/12) Pp. 69-84

https://doi.org/10.6902/JNTUST.202112_8(1).0004

摘要

本文為一位卵巢癌末期病人之整合性照護經驗。護理期間為109年12月10日至109年12月24日，以羅氏適應模式進行整體性評估，藉由會談、身體評估、觀察以及查閱病歷等方式收集資料，確認護理問題有：營養狀況改變：少於身體需要、噁心、口腔黏膜障礙、現存性感染、組織灌流失效、慢性疼痛、皮膚完整性受損、死亡焦慮、預期性哀傷等，住院期間會同婦癌醫師、外科醫師、護理師、傷口照護師、營養師、安寧共照護理師及藥師，偕同個案及家屬共同參與醫療決策，提供跨團隊整合性，照護。協助緩解疼痛、症狀療法及完成未了心願，並由醫療團隊與個案及家屬共同討論，簽立預立安寧緩和醫療暨維生醫療抉擇意願書，引導個案與家人相互道謝、道愛、道歉與道別之四道人生。藉由此照護經驗，分享跨領域團隊合作整合性照護的理念，以提升臨床照護品質並因應病患和家屬之需求，達到善終。

關鍵字

卵巢癌末期 ； 整合性照護 ； 跨領域團隊照護

並列摘要

This case report describes the experience of interprofessional collaborative care in a patient with advanced stage ovarian cancer. The nursing period was from December 10, 2020 to December 24, 2020. All information was collected through observation, communication, physical assessment, and medical chart record. Roy's adaptation model was employed to evaluate the patient's health-related problems, including chronic pain, ineffective tissue perfusion, impaired skin integrity, nausea, impaired oral mucous membrane, inadequate nutrition for the body's requirements as well as death anxiety, and anticipatory grieving. During hospitalization, an allied health professional, gynecologic oncologist, surgeon, nurses, palliative care nurse, dieticians, and physiotherapists provided a high quality of care to the patient. The expertise of the interprofessional team developed integrated care strategies for patient pain relief, management of distress associated with symptoms and fulfilling her bucket list. The interprofessional team members discussed several issues with the patient and their family, and assisted them both with emotional expression in terms of love, gratitude, giving and seeking forgiveness, and saying farewell. The case report provided a comprehensive picture of the experience and needs of patients with terminal ovarian cancer, suggesting the importance of interprofessional collaborative care in responding to the needs of patients and their family members, thus improving the quality of nursing care necessary to have a ＂good death.＂

並列關鍵字

Advanced Stage of Ovarian Cancer ； Interprofessional Collaborative Care ； Integrated Care

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