一位胰臟癌末期病人之護理經驗

A Nursing Experience of a Terminal Pancreatic Cancer Patient

張文蓓(Wen-Pei Chang)；黃素珍(Su-Chen Huang)

尿毒症 ； 血液透析 ； 腦中風 ； 無力感 ； anticipatory grief ； hospice care ； insomnia ； nursing care ； terminal

志為護理-慈濟護理雜誌

13卷2期（2014 / 04 / 01）

70 - 80

繁體中文

本文旨在描述一位胰臟癌末期病人之安寧照護經驗。護理期間為2010年1月31日至2010年2月16日。筆者運用羅氏適應模式為評估架構，發現個案有慢性疼痛、失眠、營養不均衡：少於身體需要、預期性哀傷等問題，以安寧療護之理念，教導外傭按摩、協助病人練習深呼吸，並配合止痛藥物使用，病人之疼痛指數由9分降到3分；指導外傭於個案睡前背部按摩、配合個案默想聖經字句以協助入睡，入睡後則採集中護理，以改善其睡眠中斷現象；其次，與其外傭及小兒子討論並設計吸引個案之菜單，使其進食量增加；此外，因個案預期將要與過逝的先生見面、又放不下對孩子們的牽掛，筆者鼓勵其依靠原有信仰，以禱告和家人支持來渡過哀傷，並協助病人完成生命回顧。

This article described the hospice nursing experience of a terminal pancreatic cancer patient. The nursing period lasted from 31st January to 16th February 2010. Data were collected through interview, communication, observation and physical assessment, and Roy adaptation model was applied as nursing assessment framework. As result, the following major health issues were identified: Pain, insomnia, imbalanced nutrition: less than body requirements, and anticipatory grieving. During the nursing period, we had taught the primary caregiver and patient techniques to reduce the patient's pain, including massage and breath relaxation; when combined with the pain control medications, the pain index reduced to 3 from 9. With the help of back massage by the caregiver before sleep, bible reading and meditation to facilitate sleeping, and centralized nursing care after asleep to reduce sleep disruption, the patient's sleeping problem improved significantly. We also had family meetings to discuss the diet selection to improve the patient's appetite, and as result, the patient ingested more proteins and calories. To calm the patient's fear of coming death and attachments to her children, we utilized empathy and encouraged the patient to pray with her family according to her religion to endure the grief, and assisted the patient to complete her life review.