自主照顧行為癌末個案之護理

Nursing Care to a Terminal Cancer Patient with Autonomic Behavior

劉淑玲(Shu-Ling Liu)

《安寧療護雜誌》 11卷1期 (2006/02) Pp. 75-84

https://doi.org/10.6537/TJHPC.2006.11(1).7

摘要

本文旨在探討一位從事護理工作三十餘年之個案，在乳癌復發出現肋膜積水、呼吸喘、下肢水腫及傷口惡化，經醫師建議住進安寧病房後，所面臨的身心靈衝擊與出現自主照顧行為的護理過程。護理期間自2005年8月16日至2005年10月8日，藉直接護理、觀察、會談及十篇行為過程記錄來收集資料，分別以生理、心理、社會及靈性四個層面做整體性的評估，分析護理問題為：「蕈狀潰瘍傷口」、「親情糾葛」、「積極自主照顧」及「出院問題」。在瞭解個案過去發病、治療經驗及自主的個性後，尊重其對傷口換藥時間及方式的堅持，並配合使用遠紅外線儀器照射，減輕其對傷口惡化的焦慮。個案雖是護理人員也是藉由個別性及完善的護理措施，才改變她對安寧照顧的錯誤觀念，這讓筆者學習到面對具有醫療背景的個案時，應去除對原有角色的烙印，除尊重個案的自主性護理外，同時回歸以病人為中心的照顧模式，陪伴個案度過瀕臨死亡的恐懼。筆者希望藉此個案報告的護理經驗提出與安寧伙伴分享，以幫助日後照顧有醫療背景個案時的參考。

關鍵字

癌末個案 ； 自主照顧行爲

並列摘要

This case report was to discuss the patient who was engaged in nursing work over 30 years. She suffered from breast cancer and had symptoms such as pleural effusion, short of breath, lower limbs edema, and wound worsens. She was moved to hospice ward after doctors suggested, to facing impact on her body, mind and spirit, then appeared the autonomic behavior. During the nursing process from August 16 to October 8 in 2005, we collected data by direct nursing, observation, interview, and ten behavior-process records. We entirely estimated this case in four aspects of physiology, psychology, sociology, and spirit. Analytic the nursing problems: ”fungating wound”, ”dear families' entanglement”, ”positive autonomic behavior” and ”discharge problem”. After the realization of the patient's history of illness and treatment with her autonomic behavior, we relieve her anxiety by following her insistence of wound care and sharing remote infrared on her. Even though the patient was a nurse before, the team provided individual and comprehensive nursing care and changed her misunderstanding of hospice palliative care with. In this case, we realized that we should disregard the impression from patient's profession but focus on the patient individually and respect the autonomic behavior to help her getting through the fear of passing away. From the experience sharing of this case study, it would be helpful to understand the nursing care to the patients in the background of nursing or medicine.

並列關鍵字

terminal cancer patient ； autonomic behavior