照護一位壯年鼻咽癌末期病人無望感之護理經驗

Nursing Experience of Caring for a Middle-aged Patient with Terminal Nasopharyngeal Carcinoma

10.29494/LN.202206_23(2).0008

張曉娟(Xiao-Juan Zhang)；黃曉萍(Sheau-Pyng Huang)

鼻咽癌 ； 疼痛 ； 口腔黏膜破損 ； 無望感 ； 預期性哀傷 ； nasopharyngeal cancer ； pain ； oral mucositis ； sense of hopelessness ； anticipatory grief

領導護理

23卷2期（2022 / 06 / 01）

104 - 119

繁體中文

本文描述照顧一位壯年鼻咽癌末期併多重轉移病人產生無望感之護理經驗，護理期間自2018年6月5日至6月30日，以Gordon十一項功能性健康型態進行整體性評估，藉由身體評估、會談、傾聽、檢驗數據等方式收集資料，確認健康問題有：口腔黏膜改變、疼痛、營養狀態改變／少於身體需要、腹瀉、潛在皮膚完整性受損、睡眠型態紊亂、無望感、預期性哀傷等健康問題。個案面臨疾病造成的身體疼痛、疾病進展至末期的身心靈困擾，照護期間藉由傾聽與陪伴建立護病信任關係，鼓勵個案與家屬表達心中不安的情緒，與醫療團隊合作，依據放射線口腔黏膜炎照護指引，提供個別化的口腔黏膜衛教及飲食指導，運用輔助療法如：舒適臥位、穴位按摩、音樂療法等減輕疾病帶來的疼痛，降低個案面對癌症的無望感。住院期間接受安寧共同照護，出院轉由安寧居家，持續追蹤病人疼痛情形及提供靈性關懷。希望藉此護理經驗的分享，期許臨床護理師日後在照顧此類病人時，運用於臨床照護實務中，讓病人及家屬獲得真正身心靈的安適。

This article describes a nursing experience for a middle-aged patient with terminal nasopharyngeal carcinoma and multiple metastases developing a sense of hopelessness. During the nursing period, from June 5th to June 30th, 2018, a comprehensive assessment of Gordon's Eleven Functional Health Patterns was conducted. Information was collected through physical assessment, interviews, listening, and inspection data to confirm that the case encounters nursing issues such as: oral mucosal disorders, pain, and nutritional imbalance that was less than the body requires; diarrhea, potential skin integrity damage, sleep pattern disorder, hopelessness feelings, sorrows and anticipatory grief. The patient faces physical pain caused by the disease, both physical and mental distress prompt by the disease as it progresses to the terminal stage. During the nursing period, through listening and accompanying the patient to build trusting relationship between nursing staff and patient, the case and the family were also encouraged to express their anxiety in order to collaborate with the medical team. According to the radiation oral mucositis care guidelines, providing individualized oral mucosal health education and dietary guidance, using adjuvant therapy such as: comfortable lying position, acupoint massage, music therapy, and so forth to ease pain induced by disease and relieve the hopelessness of patients while facing cancer. During hospitalization, the patient received hospice sharing care, and was discharged to hospice care at home. The patient was tracked continually in terms of recovery and psychological care was provided. It is hoped by means of sharing this nursing experience; clinical nurses can use it as a reference in the future for practical clinical care when taking care of similar cases. Through complete and continuous care, patients and their families will attain genuine physical and mental comfort.

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