一位尤文肉瘤癌末青少年之安寧照護經驗

Hospice Care for a Teenage Patient with End-stage Ewing's Sarcoma

蘇愷琪(Kai-Chi Su) ； 吳秀春(Hsiu-Chun Wu)

《馬偕護理雜誌》 7卷2期 (2013/07) Pp. 60-70

https://doi.org/10.29415/JMKN.201307_7(2).0006

摘要

本文旨在描述一位末期肉瘤合併肺臟和骨頭轉移之青少年，面臨癌末身體不適和臨終焦慮之護理經驗。護理期間為2010年6月1日至2010年6月17日，運用羅氏適應模式與個案會談、收集主客觀資料並進行生理、心理、社會之整體評估，再予歸納分析以確立個案主要生理問題有呼吸困難、疼痛，和因生理病痛、瀕臨死亡所引發之焦慮情緒，案母有面臨將失去愛子之預期性哀傷問題等。在護理過程中，個案因失去自我控制感，而顯得不安，與醫療人員互動時，顯得冷漠甚至有敵對情形，因此護病關係建立困難，筆者運用安寧照護理念，以主動關懷、同理、傾聽、溝通，陪伴及協助身體清潔護理等，建立良好護病信任關係，協助減輕個案生理病痛，引導、抒發及包容個案和家屬宣洩負面情緒等，並提供心理支持與安慰，另透過安寧團隊支持，協助案母面對個案死亡之心理準備，與遺族關懷及哀傷反應追蹤。期盼經由此臨床照護經驗分享，能提供護理人員日後照護病人之參考，以提升臨終病人更完善的照護品質。

關鍵字

尤文氏肉瘤 ； 癌末 ； 青少年 ； 安寧照護

並列摘要

This article describes the nursing care for a teenage patient, who has end-stage Ewing's sarcoma with lung and bone metastasis, experienced symptoms of terminal disease and anxiety before death. The nursing care was performed from June 1st to June 17th, 2010, using Roy Adaptation Model and case interview to collect objective data in order to perform physical, mental and social assessment. The data was then analyzed conclusively to confirm the case's main physical problems such as dyspnea, pain, and anxiety induced by physical pain and upcoming death. The patient's mother had also experienced expected distress of losing love ones. During the nursing care, patient's emotion was unstable due to lose of self-control, and he appeared to be indifferent and hostile when contacting health professionals, which caused difficulty to build relationship with patients. Author used hospice care principles to proactively provide care, understand, listen, communicate, accompany and assist patient for body cleaning care, in order to build reliable relationship, to alleviate patient's mental pain, and to induce patient and patient's family to release negative feelings. In addition, mental support and condolence were provided. Patient's mother was assisted to be ready to face patient's death. Grief responses of patient's family were also followed-up. We expect to provide other nursing staffs this care experience, in order to promote quality of care for patients with terminal disease.

並列關鍵字

Ewing's sarcoma ； end-stage cancer ； adolescent ； hospice care