一位肺癌轉移胃癌瀕死病人之照顧經驗

An Experience of Caring for a Dying Patient with Lung Cancer and Gastric Metastasis

陳淑琪(Shu-Chi Chen) ； 辛幼玫(Yu-Mei Hsin) ； 何幸美(Hsin-Mei Ho)

《高雄護理雜誌》 35卷3期 (2018/12) Pp. 130-141

https://doi.org/10.6692/KJN.201812_35(3).0012

摘要

本文為初次確診肺癌轉移胃癌瀕死病人之照護經驗，個案因疾病快速惡化，生命將進入末期而出現無望感，家人對死亡產生擔心及焦慮，害怕個案無法善終。筆者在2016年5月8日至6月1日以觀察、陪伴、會談及身體評估等方式，運用Gordon十一項評估，確立個案有「營養不均衡/少於身體需要」、「舒適情況改變」、「無望感」及「死亡焦慮」等健康問題，提供個別性照護：（一）計算所需熱量，補充高熱量輸液；（二）腹部按摩，改善腹脹症狀，促進舒適；（三）以生命回顧、社會支持及宗教信仰方式，接受病情變化並表達想法；（四）協助家屬面對病人瀕死之際，表達情感及道別，完成善終心願，使其身心靈得到安適。希望藉此經驗分享，提供照護臨終末期病人之參考。

關鍵字

肺癌轉移胃癌 ； 癌症末期心理 ； 靈性照護

並列摘要

This article aims to share the experience of a newly diagnosed case with metastatic lung cancer in a patient with metastatic lung cancer. As a result of the physical discomfort of the disease, the rapid deterioration of the disease, the hopeless feeling of life control, and in the face of the physician's declaration of limited life, both patient and family worried about death, and anxious reactions ensured with them being more afraid of dying too quickly. During the period of May 8 to June 1, 2016, the authors collected information on the basis of Gordon's 11 assessment methods, such as observation, companionship, talks and physical assessment, to establish ＂undernourishment＂ and ＂comfort change ＂,＂ hopelessness ＂and＂ death anxiety ＂and other health problems, with medical treatment to provide individual care measures: (A) calculate the required heat input for patient comfort, add high-calorie infusion; (B) provide abdominal massage, improve abdominal distension to reduce nausea and vomiting symptoms, promote physical comfort; (C) actively cooperate with a peaceful resolution of any division, listen to the feelings of the patient, (D) assist the family in the face of this rapid turn toward the brink of death, and fully support the situation of the family members, by allowing the patient to express personal feelings, say goodbye, complete all good wishes, and in the final analysis, allow the patient's physical and mental abilities to be comfortable. We hope that by sharing this experience, we can provide nurses with a guide to care for patients in the late end of their life.

並列關鍵字

Lung cancer with gastric cancer ； cancer at the end of psychological ； spiritual care

參考文獻

李貞慧、林宜芬、金惠民(2015)‧癌末病人安寧療護之營養照護‧北市醫學雜誌，12，27-34。

林蓮馨、陳孟君(2013)‧協助一位胃癌末期合併肝轉移病人善終之護理經驗‧榮總護理，31(3)，314-320。

陳月蓉、王雅芳、郭淑華、王婉萍(2015)‧心慟不捨中放手祝福：一位末期肺癌病人知家屬預期性哀傷撫慰‧安寧療護，20(1)，79-87。

陳秀貞、唐秀治(2014)‧癌症病人預後告知的現況及影響的探討‧台灣癌症醫誌，1(2)，103-112。

鄭如芬、林雅卿、黃百后、韋至信、孫嘉玲(2014)‧癌症末期病人靈性照護模式‧護理雜誌，61(6)，93-97。