一位肝癌末期個案之護理經驗

Nursing Experiences of a Patient with Hepatocellular Carcinoma at Terminal Stage

10.6880/TJON.200806_8(1).07

張玉如(Yu-Ju Chang)；陳素根(Su-Ken Chen)；鄧慶華(Ching-Hwa Teng)

肝癌末期 ； 無望感 ； 哀傷 ； terminal-stage of hepatocellular carcinoma ； hopelessness ； anticipatory grieving

腫瘤護理雜誌

8卷1期（2008 / 06 / 01）

79 - 90

繁體中文

本文是描述一位肝癌末期合併骨轉移個案的護理經驗。照護期間為2006年9月5日至2006年9月28日，筆者經由觀察、會談等方式收集資料，運用Gordon十一項功能性健康模式做整體性評估，加以歸納分析，確立個案主要健康問題有：1.疼痛；2.自我照顧能力缺失；3.無望感；4.預期性哀傷等護理問題。在疼痛方面：提供音樂治療、穴位指壓、芳香療法等護理措施以緩解疼痛；在自我照顧方面：提供輔具使用、協助被動運動以訓練肌肉的力量，來完成日常生活活動；在無望感方面：建立希望技巧、懷舊療法以及大愛台劇場影片觀賞，以體會生命的意義及價值；在預期性哀傷方面：提供宗教信仰支持，包含慈濟師兄探望及至院設華陀公寺拜拜，並藉由不斷的傾聽、關懷與陪伴，讓個案接受疾病末期的事實，進而勇於面對死亡，體會生命意義，讓生命綻放出燦爛的光芒，走出死蔭的幽谷。

This article describes nursing experiences of a patient suffering from hepatocellular carcinoma with bone metastasis. The period of nursing care was from September 5 to 28 in 2006. The authors used observation, interview and Gordon's functional health pattern model to gather and analyze information. Four patient's problems were identified: (1) pain (2) self-care deficit (3) hopelessness (4) anticipatory grieving. Specific nursing interventions were designed for each problem. The author provided music therapy, acupressure massage, and aromatherapy to manage the patient's pain. To promote the patient abilities to complete daily activities, we performed passive exericises to improve the patient's muscle strength with the assistance of compelementary physical devices. To eliminate hopelessness, the authors administered skills to build hope and reminiscene therapy, and offer a TV program on Da-Ai Channel for the patient to watch to appreciate the significance and value of life. To solve anticipatory grieving, we provided religious support. The Tze Chi followers visited the patients, and prayed for him in the temple of the hospital. Additionally, we helped the patient accept the disease and face the death through attentive listening, caring, and accompanying the patient. Finally the patient could perceive the meaning of life, emit the sparkling light of his life, and walk through the valley of the shadow of death.