照護一位年輕女性癌末病人面對死亡之護理經驗

Nursing Care of a Young Female Cancer Patient Facing the Experience of Death

周芷安(Chih-An Chou) ； 崔宛玉(Wan-Yu Tsui) ； 王惠娟(Huey-Jiuan Wang) ； 林怡芳(Yi-Fung Lin)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 29-40

https://doi.org/10.6740/NTUHJN.201901_15(1).0004

摘要

本文描述照護一位年輕女性癌末病人面對死亡之護理經驗。護理期間為2015年9月17日至10月17日，藉由與個案及案家互動、觀察及會談，收集生理、心理、社會與靈性四個層面資料，發現個案因腫瘤傷口位置及異味造成身體心像的改變及身體虛弱導致活動功能障礙，造成社交行為退化及生活品質下降，加上病情變化無常，家屬面對個案疾病進展快速而即將面臨死亡完全手足無措，產生焦慮不安與害怕造成預期性哀傷。因此應用復健運動及藝術治療，提供個別性護理措施，透過復健計畫、陪伴、主動關懷及了解個案需求與內心感受，使其能接受身體心像改變的事實，增加身體活動功能及減輕心理焦慮，提升日常生活品質及調適面對死亡的事實。臨床工作發現腫瘤病人病情變化迅速，雖有規劃，但病人仍常常來不及有妥善的善終準備，期望藉由此個案之護理經驗分享，建議臨床醫護人員照護此類病人，應盡早安排復健運動與安寧緩和共照護理，避免造成遺憾。

關鍵字

藝術治療 ； 復健運動 ； 上皮樣肉瘤

並列摘要

Through clinical observation, cancer is found not to be a disease exclusive to the elderly. However, since the treatment for the younger patients tends to be more active, hospice care is often too late for the patients. In fact, it is often overlooked that the feelings of weakness resulting from chemotherapy or long-term bed rest can cause great spiritual suffering (e.g., being worried about becoming a burden for the family or a useless person) for terminal cancer patients. We collected data through observations, physical assessments, and interaction with patient. We identified the patient's health issues, including body image changes, impaired physical mobility, and anticipatory grieving. When terminal cancer patients lose their self-care ability due to weakness, they may suffer from depression and feel hopeless. At this time, providing an appropriate rehabilitation exercise in terminal stage have become considerably important for cancer patients. Moreover, using photographs and art therapy to bring these young patients, who are facing the soon-coming death, to look back at their whole life may greatly help them express their thoughts, goodbyes and gratitude to their family members.

並列關鍵字

art therapy ； rehabilitation exercises ； palliative care