癌末病人撤除氣管內管之照護經驗

詹璧華; 梁惠茹; 賴維淑; 釋宏琳

doi:10.6537/TJHPC.202107_25(3).06

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P284 - 297

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6537/TJHPC

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癌末病人撤除气管内管之照护经验

Care Experience of Withdrawing Life-sustaining Treatment for a Terminally Ill Patient

詹璧华(Pi-Hua Chan) ；梁惠茹(Hui-Ju Liang) ；赖维淑(Wei-Shu Lai) ；释宏琳(Hung-Lin Shi)

安宁疗护杂志； 25 卷 3 期 (2021 / 07 / 01) ， P284 - 297

繁体中文 DOI： 10.6537/TJHPC.202107_25(3).06

末期病人；撤除维生医療；倫理； terminally ill patient ； withdrawal of life-sustaining treatment ； ethics

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摘要 │ 参考文献 (20) │ 国际计量

摘要〈TOP〉

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Medical treatment is progressing day by day, and many medical measures can prolong the life of patients. However, when medical treatment has caused great suffering to the terminally ill patients, they have the rights to refuse futile life-sustaining treatment. Patient autonomy, rigorous evaluation, and high quality of care plans before, during, and after removal are needed when medical team offer a patient Withdrawing Life-Sustaining Treatment (WLST). This article described the nursing experience of a patient with end-stage nasopharyngeal carcinoma. After the diagnose of cancer, this patient received medical treatment at the other hospital. This time, the patient was sent to the emergency department of our hospital due to dyspnea. Because of unclear medical condition of the patient, endotracheal tube was inserted to help him breathe. The patient had expressed to the medical team the desire to remove the endotracheal tube, but his wife could not bear involvement of the aged father and the adult children and decided to face the evacuation process alone. Thus, this case was selected for in-depth discussion. The nursing period was from January 9 to January 14, 2020. During the process, data was collected by means of reading medical records, physical assessments, interviews, and companionship. A comprehensive assessment was conducted to identify the major health-related problems: head and neck pain, dyspnea, and that his wife was facing pressure and anticipatory grief caused by this medical decision. Through nursing care such as pain assessment, providing analgesics and sedatives, comfort care to relieve pain and dyspnea, guiding emotional expression of the patient's wife, serving as the bridge of communication among the patient, the wife, and the sons, and conducting case conference and family conference, the patient and his family members received good quality of care, the wife's decision-making pressure was relieved, and building consensus among family members. To keep peace among the patient, his family members and the medical team, we made the withdrawal decision in line with ethics and laws via weighing the benefits and harms given by ethical analysis, and provided anticipatory grief care. We hope that the sharing of care experience can be used as a reference for clinical care.

参考文献 ( 20 ) 〈TOP〉

吴莉芬,洪玉纯,陈昱光,何景良,张乃文,潘雪幸(2016)。末期病人撤除维生医療－安寧共同照护介入之经验。肿瘤护理杂志，16(2)，5-14。
连结：
林佑桦(2017)。癌症生命末期病人维生治療的撤除与不给予之议题。护理杂志，17，17-26。
连结：
黄馨葆,许淑欣(2016)。不予及撤除维生医療之护理实务。彰化护理，23(1)，2-5。
连结：
杨婉萍,劉芊葳,宋圣芬(2018)。在死亡与苦难前相濡以沫─癌末病人家属的靈性照护。护理杂志，65(3)，22-27。
连结：
Hoven, BVD,Groot, YJD,Thijsse, WJ,Kompanje, EJO(2010).What to do when a competent ICU patient does not want to live anymore but is dependent on life-sustaining treatment? Experience from The Netherlands.ICM,36(12),2145-2148.

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