運用關懷及安寧療護理念於胃癌末期病人之護理經驗

Applying Watson's Caring Theory and Palliative Care Concepts to A Patient with Terminal Gastric Cancer

張雅欣(Ya-Hsin Chang) ； 董依真(Yi-Chen Tung)

《澄清醫護管理雜誌》 12卷4期 (2016/10) Pp. 54-63

摘要

本文運用Watson關懷理論及安寧緩和療護協助一位胃癌第三期之中年病人，個案因意識改變入急診求治，醫師診斷為胃癌末期合併腹膜轉移，建議家屬採安寧緩和療護，期望改善患者在生命末期之照護品質，護理期間為2014年2月10日至3月19日，筆者運用Watson關懷理論作為評估工具，藉由觀察、傾聽、治療性會談、翻閱病歷來收集資料，確立個案之主要護理問題有（1）低效性呼吸型態；（2）體液容積過量；（3）家屬預期性哀傷等問題，筆者運用舒適護理緩解個案因癌症末期所帶來生理上之不適，也協助家屬因應個案預期性死亡所帶來之衝擊，給予提供相關之心理輔導，期盼本文能喚起護理人員對末期病人症狀照護之重視及家屬的心理需求，透過安寧療護理念的運用，以達到生死兩相安及善終的目的。

並列摘要

In this paper, Watson's caring theory and palliative care concepts were applied to a middle-aged patient with gastric cancer at stage three. This patient went to a hospital's emergency room due to changes in consciousness. A terminal gastric cancer with peritoneal metastasis was subsequently diagnosed. The patient and their family were advised to adopt palliative care, expect improve the quality of care at the end of the patient's life. During the period of nursing care from February 10th to March 19th, 2014, Watson's caring theory was used as an assessment tool. Data was collected via observation, listening, therapeutic conversation, and chart review in order to establish the patient's primary care issues of (1) ineffective breathing patterns, (2) excess fluid volume, and (3) anticipatory grieving issues within the family. Comfort care was delivered to alleviate the patient's physical discomfort. A counseling support system was also offered to the family to enable them to cope with their own bereavement. It is hoped that this article will raise awareness of issues in relation to symptom management in palliative care and the psychological support needed for grieving families. The application of the palliative care concept in creating a quality environment for terminal patients seeks to improve the quality of life for both the patient and their family. As a result, a smoother transition from life to death can be achieved.