一位肝癌末期個案面臨死亡焦慮之護理經驗

A Nursing Experience of a Terminal Stage Hepatocellular Carcinoma Patient Suffering from Death-Induced Anxiety

吳曉玟(Hsiao-Wen Wu)；謝春金(Chun-Chin Hsieh)

肝癌末期 ； 死亡焦慮 ； Watson關懷理論 ； death anxiety ； hepatocelluar carcinoma ； terminal stage ； Watson care theory

志為護理-慈濟護理雜誌

13卷1期（2014 / 02 / 01）

90 - 100

繁體中文

本文敘述一位85歲個案罹患肝癌末期合併腹水，除須調適癌症所帶來的生理不適外，還面臨到因無法預測疾病過程而產生死亡焦慮之護理經驗。於2011年7月5日至2011年7月16日，藉由整體性評估、觀察及會談等方式，收集身、心、社會及靈性各層面資料，確立個案有體液容積過量、失眠及死亡焦慮之健康問題。運用Watson關懷理論為基礎，教導穴位按摩、控制鹽、水的攝取量以維持體液容積的平衡；鼓勵白天下床活動，睡眠時減少周遭環境噪音干擾以改善睡眠品質，鼓勵其說出內心真實感受，藉由彼此信任關係的建立，提供支持性、保護性的身、心、靈及社會文化之全人照護。期望藉此經驗的分享，有助於提升對於肝癌末期患者之照護品質。

This report described the special nursing experience of an 85 years-old patient diagnosed with terminal stage hepatocellular carcinoma (HCC) complicated with ascites. In addition to the physical discomfort, this patient also faced the anxiety due the unpredictable disease progress. From July 5, 2011 to July 16, 2011, through compressive evaluation, observation as well as consultation, we collected the data on physical, psychological, societal, and spiritual aspects of this patient and identified the following major health issues: fluids overload, insomnia, and death-induced anxiety. During the nursing period, we taught the patient, based on Watson's care theory, acupuncture point massage and the control of water and salt intake. We encouraged the patient to increase day-time activities and to reduce ambience noise to improve sleeping quality; to be forthcoming with genuine feelings to overcome the death-induced anxiety. By establishing a mutual trust, we offered a supportive and protective environment for the patient provided a holistic care encompassing physical, psychological, spiritual, social and culture aspects. We hope to contribute towards the quality of care for terminal liver cancer patients by sharing this special nursing experience.