結合安寧共照照顧一位大腸癌末期病人之護理經驗

The Nursing Experience in Care of a Terminal Colorectal Cancer Patient with Hospice Shared Care

10.6540/NTJN.202103_23(1).0010

鍾瑞齡(Jui-Ling Chung)；蘇怡勲(Yi-Hsun Su)

大腸癌末期 ； 安寧共照 ； 無望感 ； terminal colorectal cancer ； hospice-shared care ； hopelessness

新臺北護理期刊

23卷1期（2021 / 03 / 01）

101 - 110

繁體中文

本文探討一位末期大腸癌病人因病程逐漸惡化，於面臨瀕死前，接受安寧共同照護之護理經驗。筆者於2018年5月3日至2018年6月4照護期間，藉由觀察、會談、身體評估、團隊討論及查閱病歷收集資料，運用整體性護理評估病人的健康問題，確立有疼痛、無望感與哀傷之健康照護問題。照護期間，與病人建立治療性關係，藉由提供穴位按摩、芳香療法減輕疼痛；給予傾聽、陪伴，引導病人表達內心感受，減輕無望感；運用傾聽、陪伴協助病人以宗教信仰獲得心靈安適，同時傾聽家屬即將面對病人死亡的哀傷，提供個別、全面且連續性的照顧，並協助以道謝、道愛、道歉、道別四道人生，引導病人回顧生命的歷程，思考、評價過去人生事件，能夠學會欣賞、讚賞、感謝、放下，達到生死兩相安目的。此次照護最大的困難及限制是個案一直抱持著可治癒的期望，在溝通協調初期常遭受個案與家屬的拒絕，導致醫病關係凍結，無法取得安寧緩和醫療的認同，建議安寧團隊能於癌末病人治療效果有限時，能即時介入，讓病人與家屬及早獲得高品質照護。以此安寧共同照護經驗，提供臨床護理人員照顧相似病人時之參考。

This article discusses the nursing experience of hospice-shared care for a moribund patient with advanced colorectal cancer. Data were collected through observations, interviews, physical assessments, review of medical records, and team discussions during the period of hospice shared care from May 3^(rd) to June 4^(th), 2018. Holistic care was applied and identified that the patient was suffering from health issues with pain, hopelessness, and grief. The care team established a therapeutic interpersonal relationship with the patient during the nursing period, alleviated pain by providing acupressure and aromatherapy, gave listening and companionship to guide the patient to express their inner feelings, relieve their hopelessness, and achieve spiritual comfort through religion. With an individual, comprehensive and continuous care, the team led the patient to review the course of life, think about and evaluate the past and learn to express apologies, gratefulness, love, and farewell, i.e., four themes of life, to the family. Therefore, all of them could positively face sorrow during the final stage of the patient's life and leave no regrets for both patient and family. The biggest difficulty of the care is that the patient always held the expectation of being curable. In the initial coordination, the team was often rejected by the case and family, which led to the freezing of the medical relationship and the inability to implement hospice palliative care. Hence an early intervention of a hospice care team is recommended when the treatment effect is limited. The experience from this article will be able to help both patient and family with a higher quality of care.

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