照護一位大腸癌末期病人臨終之護理經驗

A Nursing Experience of Caring for a Colorectal Cancer Patient at the Terminal Stage

10.6692/KJN.202004_37(1).0012

梁詩柔(Shih-Rou Liang)；朱盈蓉(Ying-Jung Chu)；廖婉君(Wan-Chun Liao)

癌末 ； 無望感 ； 臨終照護 ； cancer ； hopelessness ； hospice care

高雄護理雜誌

37卷1期（2020 / 04 / 01）

137 - 149

繁體中文

本文敘述一位大腸癌末期病人合併肺轉移面對病情惡化家屬面臨病人臨終時心中之不捨與矛盾，造成身體、心理衝擊之護理經驗。護理期間為2017年7月5日至8月1日，藉由身體評估、觀察及會談方式收集身、心、社會、靈性等層面資料；經由分析歸納確立個案主要照護問題為低效性呼吸型態、疼痛、無望感、家屬預期性哀傷。住院期間運用以病人為中心的照護方式，教導病人與家屬放鬆、噘嘴吐氣方式及維持舒適臥位緩解呼吸困難；運用疼痛控制促進舒適；透過建立互信的治療性關係，經醫療團隊協助下，個案藉由傾聽、陪伴及生命回顧，降低負向情緒，肯定其生命意義與價值重建希望，進而與家屬共同面對死亡。期能藉由此照護經驗，做為護理師日後臨床照護之參考。

This paper presents a special nursing care experience about a colorectal cancer case with advanced lung metastasis expressing depressed feelings about his poor progress, and his family members struggling to accept the impending death of this patient. These contradictory emotions shocked both the patient and his family's mental status. During the nursing period from July 5th to August 1st, 2017, the author collected Physical, Mental, Social and Spiritual information through physical examination, observation and interview to assess this patient health problems, which were confirmed as inefficient respiratory pattern, pain, hopelessness, and anticipatory grief of the family. During hospitalization, we expressed a patient-centered caring way to teach the patient's family and the patient how to alleviate dyspnea via relaxation, to use pursed-lip breathing exhalation and maintenance of a comfortable position, and how to reduce pain via pain control, in order to solve the hopelessness and anticipatory grief of the family. We established a mutual therapeutic relationship in which we created companionship by listening to his struggling feelings, so that he could review his life to reduce negative emotion and reestablish the meaning of life, and we also combined the above methods to assist his family together in facing the patient's death. We hope to share this unique caring experience as a reference when nursing such kinds of patients filled with hopelessness, reluctance and fear of facing death.

1. 陳香君(Xiang-Jun Chen);杜慧娟(Hui-Chuan Tu);吳金玲(Chin-Ling Wu);蔡麗琴(Li-Chin Tsai)(2024)。一位大腸直腸癌末期病人之臨終照護經驗。高雄護理雜誌。41(2)。155-166。