一位口腔癌末期病人接受安寧共同照護之護理經驗

A Hospice Shared Care Experience of Caring for a Patient with End-Stage Oral Cancer

10.6142/VGHN.202203_39(1).0008

雷舜華(Shung-Hua Lei)；林慧屏(Hui-Ping Lin)；宋淑英(Shu-Ying Sung)；張淑芳(Shu-Fang Jhang)

口腔癌 ； 末期病人 ； 安寧共同照護 ； 善終 ； oral cancer ； terminally ill patient ； hospice shared care ； good death

榮總護理

39卷1期（2022 / 03 / 01）

73 - 80

繁體中文

本文旨探討照顧一位口腔癌末期病人的安寧療護經驗，面對疾病復發無法行治癒性治療，進而接受安寧緩和療護的護理過程。護理期間自2019年10月15日至11月3日，透過直接照護、身體評估、筆談等方式，以生理、心理、社會、靈性等四大層面進行整體性評估，因腫瘤蕈狀傷口，傷口的疼痛且伴隨大量滲液及出血，病人對病情感到焦慮及害怕，評估有疼痛、皮膚完整性受損及預期性哀傷等三項健康問題。運用芳療精油及止血敷料降低傷口出血及惡臭味，與安寧團隊合作擬定照顧計畫，運用安寧全人、全家、全程、全隊四全照護理念與病人建立信任的關係，以傾聽、陪伴、生命回顧，鼓勵病人表達其未完成的心願，藉由宗教信仰及家人支持，緩和病人與家屬預期性哀傷情緒，好好的行四道人生。期許此次照護經驗與同儕分享，為未來照護類似個案參考，提升臨床護理照護之品質。

This article describes the nursing experience of applying shared hospice care to a patient with terminal oral cancer. The patient exhibited a rapidly declining condition with no curative treatment and had a fear of death. The duration of nursing care was from October 19 to November 3, 2019. Data were collected through observation, interviews, physical assessment, and direct patient care. The patient was evaluated through physical, psychological, social, and spiritual assessment to ensure a holistic health assessment. The main health issues were pain, defect of skin integrity, and anticipatory grief. The trust of the patient with the family was gained, and they were supported through the establishment of a nurse-patient relationship. The care approach used the hospice concepts of the whole person, whole family, whole course, and whole team. Interventions included the comfort nursing technique, wound care of the fungating wounds to alleviate pain and odor, and other measures for relieving pain. In cooperation with the hospice team, a care plan was developed, and a friendly and trusting relationship was established in which the team listened to, accompanied, supported, held family meetings, assisted in the life review, encouraged the patient to express his unfulfilled wishes, and helped the patient to overcome the grief of death through religious beliefs and family support. Therefore, it is recommended to establish a care plan for patients with terminal cancer and work with hospice team members to improve the quality of life of the patient and family members. I hope to share this care experience with peers for similar case caring in the future to improve the quality of clinical nursing.

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