照護一位脾臟癌末期病人面對死亡恐懼之護理經驗

本文係探討一位脾臟癌末期個案因疾病進展迅速而產生嚴重死亡焦慮的護理經驗，照護期間個案只要聽到生理監視器的聲響便會感到恐慌，時常盯著生理監視器看，並表示自己喘不過氣要死掉了，自述害怕在睡夢中去世，恐懼感嚴重影響身心狀況，進而引發探討動機。護理時間自2019年6月3日至6月25日，依生理、心理、社會及靈性四個層面進行護理評估，發現個案有噁心嘔吐、死亡恐懼、照顧者角色緊張等健康問題，照護期間針對問題提供個別性護理措施：衛教飲食選擇原則，也可藉由姿勢擺位、穴位按摩、芳香療法等非藥物處置緩解噁心嘔吐；死亡恐懼方面，照會宗教師及心理師，引導個案表達負面情緒，陪伴個案渡過因生理監視器上的數值變化而產生的不安，使個案能得到善終；引導案夫表達負面情緒，協助其扮演適當的角色功能，以緩解照顧者角色緊張。照護過程中發現照護心靈層面對於緩解死亡焦慮的重要性，建議增加非安寧病房臨床護理師對死亡恐懼的溝通技巧，以及增加宗教師探訪頻率，協助病人達到善終。期望藉此護理經驗能提供照護臨床末期病人心靈需求的參考。

關鍵字

脾血管瘤；噁心嘔吐；死亡恐懼；照顧者角色緊張

並列摘要

This article describes the nursing care experience involving a patient with splenic hemangioma which progressively caused thanatophobia. The data were collected through interviews, observations, and physical examinations from June 3 to June 25, 2019. The data were based on the physical, psychological, social, and spiritual aspects of the nursing assessment. The health problems experienced by the client included nausea, vomiting, thanatophobia, and caregiver role strain. Individual nursing care is provided during this process which comprises teaching the patient about appropriate food choices and specific positions to alleviate nausea and vomiting, acupressure massage, and aromatherapy. Furthermore, consulting with a clinical Buddhist chaplain and psychologists assisted the patient to express emotions. Moreover, the patient experienced anxiety from physiological monitoring, and her husband was assisted to express his emotions and provided with support to care for the patient. Throughout the nursing process, the importance of spiritual care is acknowledged. Thus, this study recommends increased visits from the clinical Buddhist chaplain. This experience is intended to help other nursing staff provide mental support and mitigate anxiety among patients.

並列關鍵字

splenic hemangioma ； nausea and vomiting ； thanatophobia ； caregiver role strain

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