運用Swanson關懷理論照護一位口腔癌末期個案之護理經驗

A Nursing Experience of Applying the Swanson's Caring Theory to a Patient With Terminal Oral Cancer

黃郁琇(Yu-Siou Huang) ； 張嘉珣(Chia-Hsun Chang)

《馬偕護理雜誌》 14卷2期 (2020/07) Pp. 45-56

https://doi.org/10.29415/JMKN.202007_14(2).0005

摘要

本文探討一位口腔癌末期個案因腫瘤蕈狀傷口導致疼痛、惡臭及外觀改變，又因癌症末期面臨死亡威脅進而產生焦慮、害怕等情緒之照護經驗。照護期間2018年6月6日至2018年7月25日，運用Gordon十一項健康評估工具，藉由身體評估、病歷查閱、觀察及訪談等方式收集資料，發現有疼痛、組織完整性受損及死亡焦慮等健康問題。面對個案的焦慮及家屬的徬徨無助，筆者引用Swanson關懷照護理論的「了解、在旁陪伴、為她做某些事、使她能夠、維持信念」之五個步驟建立治療性人際關係，透過提供個別性照護來改善蕈狀傷口導致的惡臭、滲液及疼痛情形，增加病人舒適、減輕痛苦，並結合安寧團隊力量協助個案及重要親屬完成四道人生（道愛、道謝、道歉、道別），化解面對臨終的悲慟與恐懼，以尊嚴、內心平安走完人生最後一哩路。期望藉此個案照護經驗分享，提供臨床護理人員照護類似個案時之參考。

關鍵字

口腔癌 ； 末期照護 ； 死亡焦慮 ； Swanson關懷理論 ； 四道人生

並列摘要

This article described nursing process of caring a patient with terminal oral cancer with pain, malodor, and appearance changes caused by malignant fungating wound. The patient also experienced anxiety because of facing the fear of death. Data were collected using the Gordon's 11 Functional Health Patterns through observation, interview, and physical assessment from June 6 to July 25, 2018. The established main problems were: pain, impaired tissue integrity, and death anxiety. Furthermore, the author applied the five steps of Swanson's caring theory: ＂knowing, being with, doing for, enabling, and maintaining belief＂ to building a trusting patient-nursing relationship. We implemented special fungating wound care to reduce the odor, discharge and pain; comfort patient and improve patient's quality of life. Exercises further encouraged patient and family members to express their feelings and the mental distress regarding death; fulfilling of the four principles of life (love, gratitude, forgiveness, and grace in bidding farewell) with palliative care assistance and better preparing for death. This nursing experience may provide a clinical reference in caring for such cases in the future.

並列關鍵字

oral cancer ； end of life care ； death anxiety ； Swanson's caring theory ； four principles of life