照護一位急性淋巴性白血病病人面對死亡恐懼之照護經驗

Nursing Care Experience of an Acute Lymphoblastic Leukemia Patient with Fear of Death

黃郁棋(Yu-Chi Huang) ； 洪燕萍(Yen-Ping Hung) ； 陳瑞儀(Jui-Yi Chen)

《臺大護理雜誌》 14卷2期 (2018/07) Pp. 98-109

https://doi.org/10.6740/NTUHJN.201807_14(2).0010

摘要

本文係探討一位妊娠末期診斷急性淋巴性白血病病人，因治療成效不佳，最終面臨選擇無效性醫療或安寧緩和照護之護理經驗。於2015年5月26日至2015年6月28日護理期間，依Gordon 11項功能性健康型態評估，發現個案有高危險性感染、舒適情況改變、死亡恐懼等健康問題。在照護期間與個案建立良好的治療性關係，並針對問題提供個別性的護理措施，提升身體舒適程度外，照護過程中多次主動向安寧共同照護小組諮詢，並依照安寧緩和醫療概念，以主動關懷、鼓勵個案與家屬表達情感、瞭解生命的價值與意義，讓個案與家屬提早準備面對死亡課題，使個案能無憾的達到善終，建議護理人員可藉由跨團隊合作提升整合性照護。期望藉由此護理經驗，提供臨床護理師瞭解年輕癌症個案面對死亡的照護經驗作為分享，降低恐懼的威脅，提升臨終前準備的照護品質。

關鍵字

急性淋巴性白血病 ； 恐懼 ； 安寧緩和照護

並列摘要

This article discusses the nursing experience of caring for a patient diagnosed with acute lymphoblastic leukemia (ALL) during late pregnancy. The patient had a poor response to therapy and had to resort to palliative (hospice) care in the end. The duration of nursing care was from May 26th to June 28th, 2015. According to Gordon's functional health patterns, the nurse confirmed that the patient was at a high risk of infection and had comfort impairment and a fear of death. We established good rapport with the patient and promoted her physical and mental comfort by providing individualized care. The nurse encouraged the patient to express her love for her family, understand the value of life, and prepare for her imminent death so that the patient could reach the end of her life without regret. We also actively consulted the hospice team multiple times to help the patient and family prepare for their final farewell. We recommend that the nursing staff performs integrated care by promoting inter-disciplinary collaboration. We hope that through our experience, others will understand how to care for young terminal cancer patients, help them eliminate fear, and improve the quality of nursing care.

並列關鍵字

acute lymphoblastic leukemia ； fear ； hospice care