運用Swanson關懷理論於一位癌末病人死亡焦慮之護理經驗

Applying Swanson's Theory of Caring to Managing Death Anxiety in a Patient With Terminal Colon Cancer

10.6142/VGHN.202112_38(4).0012

黃雅君(Ya-Chun Huang)；梁天麗(Tien-Li Liang)

疼痛 ； 死亡焦慮 ； 靈性困擾 ； Swanson關懷理論 ； pain ； death anxiety ； spiritual distress ； Swanson's theory of caring

榮總護理

38卷4期（2021 / 12 / 01）

429 - 435

繁體中文

本文是運用Swanson關懷理論於一位罹患大腸癌男性病人，因確診後疾病快速進展，面對死亡焦慮的護理經驗，照護期間為2018年7月31日至8月29日。筆者運用觀察、會談、理學檢查與實驗室資料方式收集資料，針對病人生理、心理、社會與靈性四大層面進行整體性評估，確立病人有疼痛、死亡焦慮及靈性困擾等護理問題。因病程進展迅速，曾經轉至安寧病房，又因死亡焦慮而反悔要求轉回病房，筆者認為應當運用Swanson關懷理論協助病人安頓身心，經由「了解」病人、「在旁陪伴」傾聽、提供訊息以及「為他做某件事」緩解其身心靈的不適，進一步引導病人訴說面對死亡的看法，「使他能夠」恢復心中平靜，護理過程中協助病人「維持信念」，最後得以善終。8月29日病人在家人陪伴、身心寧靜的狀態下離世。在照護的歷程中，筆者發現當護理人員接受死亡是人生的一部分時，自身才能以更開放的態度與病人談論死亡，並協助渡過臨終的歷程。

Swanson's theory of caring was employed for a patient with terminal colorectal cancer who was experiencing death anxiety. Nursing care was provided between July 31 and August 29, 2018. Data were collected through observation, interviews, and physical assessments. The associated health problems included pain, death anxiety, and spiritual distress. Interventions such as ＂knowing,＂ ＂being with,＂ ＂doing for,＂ ＂enabling,＂ and ＂maintaining belief＂ were applied to manage the patient's death anxiety and spiritual distress. In addition, we guided the patient to talk about their view of death, restore their peace of mind, ＂maintain faith＂ during the nursing process, and finally, achieve a peaceful death. On August 29, the patient died in the company of family. By accepting death as a natural part of life, nurses can more easily talk openly about it with patients and guide them through the dying process.

1. 王嘉宏(2020)。大腸癌新藥介紹：Braftovi®。腫瘤護理雜誌，20(2)，11-15。
   連結：
2. 蔡逸鈴,林耀盛(2016)。臨終處境現象：一位癌症末期患者的心理經驗。應用心理研究，64，173-223。
   連結：
3. Davies, A. N.,Elsner, F.,Filbet, M. J.,Porta-Sales, J.,Ripamonti, C.,Santini, D.,Webber, K.(2018).Breakthrough cancer pain (BTcP) management: A review of international and national guidelines.BMJ Supportive & Palliative Care,8(3),241-249.
4. Grossman, C. H.,Brooker, J.,Michael, N.,Kissane, D.(2018).Death anxiety interventions in patients with advanced cancer: A systematic review.Palliative Medicine,32(1),172-184.
5. Kisvetrová, H.,Klugar, M.,Kabelka, L.(2013).Spiritual support interventions in nursing care for patients suffering death anxiety in the final phase of life.International Journal of Palliative Nursing,19(12),599-605.
6. Krikorian, A.,Limonero, J. T.,Maté, J.(2012).Suffering and distress at the end-of-life.Psycho-Oncology,21(8),799-808.
7. Lillykutty, M. J.,Samson, R.(2018).Insights from Kristen M Swanson's theory of caring.Asian Journal of Nursing Education and Research,8(1),173-177.
8. Menzies, R. E.,Zuccala, M.,Sharpe, L.,Dar-Nimrod, I.(2018).The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials.Journal of Anxiety Disorders,59,64-73.
9. Shirkavand, L.,Abbaszadeh, A.,Borhani, F.,Momenyan, S.(2018).Correlation between spiritual well-being with satisfaction with life and death anxiety among elderlies suffering from cancer.Electronic Journal of General Medicine,15(3),em20.
10. Singh, P.,Chaturvedi, A.(2015).Complementary and alternative medicine in cancer pain management: A systematic review.Indian Journal of Palliative Care,21(1),105-115.
11. Skalla, K. A.,Ferrell, B.(2015).Challenges in assessing spiritual distress in survivors of cancer.Clinical Journal of Oncology Nursing,19(1),99-104.
12. 行政院衛生福利部 (2020)．死因統計年報．https://www.mohw.gov.tw/cp-3795-41794-1.html
13. 吳尚倫,謝政智(2017)。癌症相關疼痛之藥物治療新觀念。臺灣臨床藥學雜誌，25(2)，100-108。
14. 黃郁棋,洪燕萍,陳瑞儀(2018)。照護一位急性淋巴性白血病病人面對死亡恐懼之照護經驗。台大護理雜誌，14(2)，98-109。

1. (2024)。面對一位未被告知罹患膀胱癌末期病人之照護經驗。彰化護理，31(2)，107-117。