一位肺癌末期病人與家庭照顧者共同面臨死亡適應過程之護理經驗

The Nursing Experience of Helping a Patient with Terminal Stage Lung Cancer and His Caregiver Adapt to Death

10.6386/CGN.202012_31(4).0009

藍堉瑄(Yu-Hsuan Lan)；林雅如(Ya-Ju, Lin)；邱白恩(Pai-En, Chiu)；陳紀雯(Chi-Wen Chen)

肺癌 ； 死亡適應 ； 護理 ； lung cancer ； death adaptation ； nursing

長庚護理

31卷4期（2020 / 12 / 01）

559 - 570

繁體中文

本文描述一位65歲罹患癌症末期個案，因疾病過程出現疼痛、呼吸困難，家庭照顧者為案妻，共同面臨死亡適應過程之護理經驗。護理期間自106年7月27日至8月18日止，運用羅氏適應模式評估工具及會談方式，收集資料，確立個案有死亡焦慮、氣體交換障礙、疼痛、及照顧者角色緊張等健康問題，護理過程中運用同理心、傾聽與陪伴及NURSE方式溝通，建立治療性關係，給予個案及案妻個別性照顧，協助個案緩解疼痛、呼吸困難等不適，在面臨死亡過程中，個案及案妻出現恐懼、害怕及焦慮等情緒，藉由陪伴、傾聽等技巧，平撫情緒並引導個案及案妻能慢慢接受、適應死亡，提升生活品質並以正向態度安然面對死亡。期望藉由此次護理經驗，作為臨床護理人員照顧此類個案之參考。

This report described the nursing experience of helping a 65-year-old patient with terminal lung cancer and his wife, a family caregiver, adapt to death. The nursing period spanned from July 27 to August 18, 2017. The Roy's adaptation model was used as the instrument, and interviews were performed to collect data. The results confirmed that the patient experienced health problems including death anxiety, impaired gas exchange, and pain. In addition, the caregiver was facing role strain. During the nursing process, the author showed empathy toward the patient and his wife, listened to them, kept them accompanied, communicated with them using the NURSE method, and thus established a therapeutic relationship with them. The author provided care to the patient and his wife individually and helped the patient alleviate discomfort due to pain and dyspnea. The patient and his wife both demonstrated fear and anxiety toward death. The author guided them to gradually accept and adapt to death. These processes improved the quality of life of the patient and his wife, allowing them to face death positively and peacefully. This nursing experience may serve as a reference for clinical nurses in caring for terminally ill patients.

1. 莊鈺如, Y. J.,陳幼貴, Y. K.,洪敏瑛, M. Y.(2015)。照顧一位小細胞肺癌末期病人之護理經驗。腫瘤護理雜誌，15(2)，95-105。
   連結：
2. Alnajar, M. K.,Darawad, M. W.,Alshahwan, S. S.,Samarkandi, O. A.(2019).Knowledge and attitudes toward cancer pain management among nurses at oncology units.Journal of Cancer Education,34,186-193.
3. Farrell, C.(2013).Bone metastases: assessment, management and treatment options.British Journal of Nursing,22,4-11.
4. García-Rueda, N.,Valcárcel, A. C.,SaracíbarRazquin, N.,Solabarrieta, M. A.(2016).The experience of living with advanced-stage cancer: A thematic synthesis of the literature.European Journal of Cancer Care,25,551-569.
5. Khrais, H.(2014).End of life outcomes for lung cancer patients who use different coping strategies: A review.Middle East Journal of Family Medicine,12(4),16-22.
6. Koller, A.,Gaertner, J.,De Geest, S.,Hasemann, M.,Becker, G.(2018).Testing the implementation of a pain self-management support intervention for oncology patients in clinical practice: A randomized controlled pilot study (ANtiPain).Cancer Nursing,41(5),367-378.
7. McPhillips, D.,Evans, R.,Ryan, D.,Daneshvar, C.,Sarkar, S. A.,Breen, D.(2015).The role of a nurse specialist in a modern lung-cancer service.British Journal of Nursing,24(4),S21-27.
8. Shore, J. C.,Gelber, M. W.,Koch, L. M.,Sower, E.(2016).Anticipatory grief: An evidencebased approach.Symptom Management Series,18(1),15-19.
9. Sugimura, A.,Ando, S.,Tamakoshi, K.(2017).Palliative care and nursing support for patients experiencing dyspnoea.International Journal of Palliative Nursing,23(7),342-351.
10. 柳秋芳, C. F.,徐書儀, S. Y.,簡淑慧, S. W.(2014)。從實證觀點談─緩解癌症病人家屬負荷之介入處置。腫瘤護理雜誌，14，59-70。
11. 郭素青, S. C.,蔡洧沂, W. I.,唐秀治, S. T.(2014)。癌症末期病患照顧者之喪親後憂鬱歷程及其影響因素。腫瘤護理雜誌，14，31-41。
12. 廖淑娟, S. C.,邱婉婷, W. T.,陳宥蓁, Y. C.(2014)。一位肺癌末期合併肋膜積水病患及其主要照顧者之護理經驗。澄清醫護管理雜誌，10(3)，42-50。
13. 衛生福利部（2017 年 6 月 13 日 ），106 年死因統計結果分析。https://www.mohw.gov.tw/dl-46171-3b6d9a1c-cc2f-4ec3-ab5e-bdb2a3097b42.html [Ministry of Health and Welfare. (2017.6.13). Analysis of statistical results of death causes. https://www.mohw.gov.tw/dl-46171-3b6d9a1c-cc2f-4ec3-ab5e-bdb2a3097b42.html]

1. 陳盈孜,李佩軒,李宇茜(2023)。一位壯年肺癌末期病人之照護經驗。若瑟醫護雜誌，17(1)，45-56。
2. 李慧玲,吳春桂(2022)。照護一位脊髓星形細胞瘤併發急性呼吸衰竭病人預立醫療決策之護理經驗。志為護理-慈濟護理雜誌，21(2)，111-120。
3. (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。