運用舒適理論於胃癌末期病人之重症安寧護理經驗

Nursing Experience of Applying Comfort Theory for a Terminal Gastric Cancer Patient with Palliative Care in an Intensive Care Unit Setting

陳姿郁(Zih-Yu Chen) ； 林芳宇(Fang-Yu Lin)

《新臺北護理期刊》 23卷2期 (2021/09) Pp. 113-125

https://doi.org/10.6540/NTJN.202109_23(2).0010

摘要

本文描述一位青壯年女性罹患胃癌末期合併多處轉移之重症安寧護理經驗，護理期間自2018年4月14日至2018年5月11日，以Kolcaba舒適理論為架構，進行整體性評估及資料整合分析後，確立個案有無效性呼吸型態／與腹部腫瘤壓迫導致肺擴張不全有關、慢性疼痛／與腹腔內惡性腫瘤侵犯有關、焦慮／與病情惡化及疾病所造成的不適症狀有關、家庭因應失能／與家庭成員對於個案醫療決策缺乏共識有關等健康問題。護理過程中教導正確呼吸技巧、配合呼吸器供氧，緩解呼吸困難；疼痛評估、給予鴉片類止痛藥物、精油按摩與音樂放鬆以緩解疼痛；同儕互動、家人情感連結與宗教信仰支持，緩解內心焦慮不安；醫護團隊對個案及家屬採持續性照護、建立良好護病關係、召開家庭會議讓家屬彼此達成共識，使個案在重症生命末期完成返家善終的心願，享有身心靈最大的平安和舒適。

關鍵字

胃癌 ； 加護病房 ； 生命末期照護 ； Kolcaba舒適理論 ； 安寧療護

並列摘要

This article describes the nursing experience of caring a female with metastatic gastric cancer, who had received palliative care in the intensive care unit. The period of nursing care was from April 14^(th) to May 11^(th), 2018. The conceptual framework of comfort theory, which composed of physical, psychospiritual, sociocultural, and environmental context, was applied in daily nursing care. Four major health problems were identified, including ineffective breathing pattern, chronic pain, anxiety, and disabled family coping. During the nursing process, we educated the patient with appropriate breathing exercises and used mechanical ventilation to reduce dyspnea. The opioid therapy was administered Depends on level of pain, essential oil massage and music therapy were also implemented for relieving pain and discomfort. We achieved the peace of mind to the patient through the interactions with her friends, connected with her family and offered the religious support. Family conference was held for effective communication and family consensus, which improved the physical, psychological, spiritual peaceful for the patient and the patient finally returned home for a good death.

並列關鍵字

gastric cancer ； intensive care unit ； end-of-life care ； Kolcaba's comfort theory ； palliative care

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