運用安寧療護理念於胃癌末期病人之護理經驗

Palliative Care of a Patient with Terminal Gastric Cancer - Nursing Experience

陳惠美(Huei-Mei Chen) ； 林素珍(Su-Zhen Lin)

《彰化護理》 27卷2期 (2020/06) Pp. 60-69

https://doi.org/10.6647/CN.202006_27(2).0010

摘要

本文旨在探討一位34歲胃癌末期病人接受安寧緩和療護之護理經驗，尤其側重於病人靈性問題之個別性護理照顧。護理期間為2017年8月20日至2017年9月19日，依生理、心理、社會與靈性四大層面進行整體性護理評估，確認病人主要有癌症疼痛、哀傷與心靈困擾三項健康問題。在照護過程中，運用安寧療護理念與疼痛控制策略，提供個別性護理措施及輔助性治療緩解疼痛症狀，持續評估疼痛程度與處置成效，增進病人身體舒適。於哀傷與心靈困擾方面，藉由積極關懷與同理，使病人在心理上獲得哀傷情緒的引導與抒發。以生命回顧的方式，協助病人提升內在支持，肯定自我價值，體悟生命的意義與內涵。並協同安寧共同照護團隊提供全人照護，協助病人與家屬共同面對死亡課題，在有限時間內為死亡做準備，完成病人臨終遺願，舉辦生前告別會，進而達成善終之照護目標。末期病人的靈性需求相當普遍，而針對靈性需求提供適切，個別性護理照顧則愈加被重視。建議臨床護理人員體認並重視靈性照護的重要，培養正向、積極、主動的態度並加強哀傷輔導技巧，以提供個別性照護進而提升癌症末期照護品質。期望藉此護理經驗分享，提供日後護理人員照顧末期癌症病人之參考。

關鍵字

安寧療護 ； 胃癌 ； 哀傷 ； 心靈困擾

並列摘要

The nursing experience of a 34-year-old female patient with terminal gastric cancer is presented, focusing on individualized nursing care of her emotional and spiritual needs. The patient was admitted for hospice care from August 20th to September 19th, 2017. After comprehensive nursing assessment, we identified the following three main problems: cancer pain, grief and spiritual distress. For the patient's cancer pain, both pharmacologic and adjuvant treatment were provided. The severity of pain and response to treatment were continuously assessed. Through tender, supportive and individualized nursing care, we ensured good pain control, maximizing the patient's comfort. As for the patient's grief and spiritual distress, we built rapport though strong compassion and empathy. We encouraged the patient to share her emotions, and through active listening and accompanying, we gradually alleviated her sadness and distress. We supported the patient to recognize the unique value and meaning of her life though life-review therapy. In order to assist the patient and family prepare for death, a living funeral was arranged under cooperation with our Hospice team. Great efforts were devoted to fulfill the patient's final wishes and to allow the patient a good and peaceful death. It is well known that high quality palliative care of terminal patients not only focuses on the patient's physical needs, but also addresses their emotional and spiritual needs. It is crucial that nursing staff recognize the importance of spiritual care and cultivate grief-counseling skills. We hope this article provides reference for nursing care of terminal cancer patients.

並列關鍵字

hospice care ； gastric cancer ； grief ； spiritual distres

參考文獻

王文佩、許心恬（2014）‧運用Swanson關懷理論照護一位肺癌末期患者靈性困擾之護理經驗‧護理雜誌，61（4），97-102.

王妍樺、童婉惠、潘慧娟（2019）‧協助一位肺癌末期病人善終之護理經驗‧腫瘤護理雜誌，19（1），91-102。

李雅萍、黃馨葆、蔡兆勳、陳慶餘、邱泰源（2012）‧癌症疼痛控制的現況‧安寧療護雜誌，17（1），62-75。

林雅萍、羅樺鈴、巫怡翎、曾斐琳（2015）‧照顧一位肝癌末期病人之護理經驗‧長庚護理，26（2），203-213。

張慎儀、胡文郁、翁開誠、釋惠敏（2014）‧生命受威脅女性癌症病人生命故事之敘事研究‧安寧療護雜誌，19（1），1-17。