癌症個案生病經驗及對精神科護理照護之反應

本研究旨在探究精神科護理師在經歷癌症病人情緒照護時，病人內在之情緒歷程以及對應之護理專業照護。本研究採現象學質性研究法，爲求能深入瞭解癌症病人的生活世界原始面貌及經驗本質結構的特色，採用個別深度訪談的方式收集資料，研究對象來自北部某醫學中心血液腫瘤科住院病人共72人，每位病人接受約60分鐘訪談對話，以詮釋現象學方式進行資料歸納與分析，發現住院癌症病人常見的情緒困擾原因有：難以接受罹癌事實、生活型態被打亂、無法忍受治療副作用、對疾病及治療的不確定感、無法掌握的擔憂及面臨死亡逼近的害怕等因素；常見之因應方式有選擇快樂過活、照往常過日子、樂觀面對等，提供之護理專業照護有同理傾聽罹病感受、提供治療相關資訊、擔任病人與家屬溝通橋樑、代言病人之疑惑並強化腫瘤科工作人員之訊息傳遞、教導放鬆技巧面對生命的有限性；而調適不良者於訪視時則出現委婉拒絕、逃避、防禦等行爲；本研究建議未來可培育專責護理人員來強化腫瘤心理衛生，並將精神衛生心理概念設計於在職教育活動中，讓腫瘤科或其他內外科護理人員也具有心理衛生相關技能，於臨床實務中主動發現病人的情緒困擾，適時轉介給精神科護理師做個別訪視，以達身、心、靈之照護。

關鍵字

癌症病人；情緒困擾；情緒照護

並列摘要

This study explored intra-emotional distress in cancer inpatients and nursing interventions by psychiatric nurses. Data were collected for inpatients at the hemato-oncology department of a Taipei medical center. Each of seventy-two cancer patients was interviewed for 60 minutes by a psychiatric nurse. Individual interviews were transcribed for analysis. Data analyzed using interpretative phenomenological method revealed the following results: cancer patients frequently had mood disturbances due to unable to accept the diagnosis of cancer, disarrayed life styles, side effects of chemotherapy, uncertainties about the course of disease and prognosis, worry about loss of control and fear of death. Coping strategies were showing happiness to live, living as usual and keeping hope. Some maladjusted patients exhibited rejection, avoidance and defensive behaviors. Nursing interventions included listening to their feelings with empathy, providing treatment information, teaching relaxation techniques, promoting communication between patients and families, patient advocacy and enhancing oncological information. This study suggests appropriate nursing procedures and education programs for psycho-oncology nursing. Medical or surgical nursing staffs should have the mental health-related skills to actively identify mood disturbances of cancer patients and, if necessary, refer them to psychiatric nursing staff.

並列關鍵字

Cancer patients ； mood disturbances ； emotional care

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