一位胰臟癌末期個案之護理經驗

本文描述一位胰臟癌末期合併骨轉移老年個案，面臨死亡的哀傷接受安寧共同照護之護理經驗，護理期間自2016年8月3日至8月15日。個案因肝轉移及骨轉移，造成背部、臀部與下肢疼痛，及食慾欠佳。筆者採用Gordon十一項功能性健康型態評估，應用直接照護、觀察、會談及身體評估等方式收集資料，確立個案有慢性疼痛、營養不均衡：少於身體所需、哀傷之健康問題。照護過程中，提供藥物與非藥物疼痛控制緩解疼痛；營養師教導個案攝取高蛋白與高熱量的飲食；透過與安寧團隊的合作共同擬定照顧計畫，與個案建立友善信任的關係，以傾聽、陪伴、支持及家庭會議、生命回顧，鼓勵個案表達其未完成的心願，藉由宗教信仰及家人支持，協助個案克服死亡的哀傷情緒。建議臨床照護癌症末期個案，能接受安寧療護，期許此次照護經驗與同儕分享，為未來照護類似個案參考，提升臨床護理照護之品質。

關鍵字

胰臟癌末期；骨轉移；安寧療護

並列摘要

This article describes an elderly case of terminal pancreatic cancer with bone metastases, facing the grief of death and the nursing experience of hospice palliative care. The nursing period was from August 3 to August 15, 2016. The case suffered pain in the back, buttocks and lower limbs and poor appetite due to liver metastases and bone metastases. The author used Gordon's eleven functional health assessments, direct care, observation, interviews and physical assessment to collect data. It was established that the case had chronic pain, nutritional imbalance: less than the body needs, and grief health problems. During the nursing process, medication and non-drug pain control were provided to relieve the intensity of pain, and instruct the case to consume a high-protein and high-calorie diet with a nutritionist, and consume enough calories. By cooperating with hospice team to develop a care plan, a friendly and trusting relationship was established with the case to listen, accompany, support, hold family meetings, have life review, encourage the case to express his unfulfilled wish, and help the case overcome the grief of death with religious beliefs and family support. Therefore, it is recommended to clinically care for the terminal cancer cases and work with hospice team members to improve the quality of life of the case and family members. I hope to share this care experience with peers for similar case caring in the future in order to improve the quality of clinical nursing care.