生死之焦～乳癌合併骨肺轉移死亡焦慮的照護經驗

癌末病人除了生理不適，面對無法控制的生命流逝更嚴重影響病人與家庭的身心健康及生活品質。本文敘述乳癌末期合併骨肺轉移之個案，筆者見個案因病況惡化而不知如何放下案女，感到焦慮且無法傾訴只能與案女相擁而泣，因此引起筆者探討之動機。照護期間自2019年1月2日至2月5日，運用整體性護理評估確立有「低效性呼吸型態」、「疼痛」及「死亡焦慮」之健康問題。筆者透過舒適擺位、噘嘴深呼吸運動合併藥物處置減緩個案生理症狀，並在護病關係建立後，利用生命回顧引導個案肯定生命價值，透過教友、醫療團隊與心理師提供心靈支持，使病人減少對於死亡的衝擊。死亡常是令人避諱的話題，如何在有限時間引導個案及其家庭願意談論並接受，往往是重大考驗。期盼藉此照護經驗給予護理人員照護死亡焦慮之病人參考及運用。

關鍵字

乳癌；低效性呼吸型態；疼痛；死亡焦慮

並列摘要

Terminal cancer patients suffer from physical discomfort and anxiety toward uncontrollable, immanent death; such psychological pressure have influence quality of both patients and their family caregivers' lives. This article described care experience of a female patient who was suffering from breast cancer with bone and lung metastasis. The nursing period was from January 2, 2019 to February 5, 2019. Data were collected through direct nursing care, interviews, and retrospective investigation on medical records. Major health problems were identified after integrated physical, psychological, social, and spiritual assessments had been conducted, such as ineffective breathing pattern, pain, and death anxiety. Both Pharmacological- and non-pharmacological therapeutic approaches, including comfort position, deep breathing, and medicine were used to alleviate the patient's physical symptoms. The reminiscence therapy was also employed to help the patient understand the value of her life. Psychological support was provided to reduce death anxiety through church friends and clinical psychologists in the medical team. The patient and her care providers have been encouraged to initiate death conversations, express the anxiety in order and adjust to changes in life. It is hoped that this nursing experience shared herein would provide nursing staffs with a reference for death anxiety care.

並列關鍵字

breast cancer ； ineffective breathing pattern ； pain ； death anxiety

參考文獻

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生死之焦～乳癌合併骨肺轉移死亡焦慮的照護經驗

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