照顧一位口腔癌末期病人之安寧善終療護經驗

An Hospice Care Experience of Caring for an End-stage Oral Cancer Patient

10.3966/168395442015121502007

許淑婷(Shu-Ting Hsu)；施秀鈴(Hsiu-Ling Shih)；潘雪幸(Hsueh-Hsing Pan)

口腔癌 ； 安寧療護 ； 善終 ； Oral cancer ； Hospice care ； Good death

腫瘤護理雜誌

15卷2期（2015 / 12 / 01）

83 - 94

繁體中文

本文旨在探討照顧一位口腔癌末期病人的安寧療護經驗，個案正值中老年時期，因工作關係很少與家人互動，故罹癌後面臨疾病的惡化，不想造成家人的負擔，對家人產生虧欠及補償心態，故引發筆者探討的動機。照護期間自2013年8月19至8月26日，藉由身體評估、病歷查閱、觀察、傾聽、會談等方式收集資料，並運用生理、心理、社會與靈性四方面進行整體性健康評估，發現個案主要健康問題有：疼痛、組織完整性受損及預期性哀傷，經由與個案及家屬建立互信的關係，運用安寧全人、全家、全程、全隊四全理念，提供個別性的護理措施，緩解個案的疼痛、改善腫瘤蕈狀潰瘍傷口的惡臭，進而使個案願意主動參與傷口照護，並藉由主動陪伴、積極關懷，緩和個案與家屬預期性哀傷情緒，讓其了解生命的意義與價值，維持生命最後的生命品質與尊嚴，達到善終。有感於臨床護理師獨自引導個案與家屬處理預期性哀傷或協助善終的能力有限，故建議可透過與安寧共同照團隊合作討論，召開家庭會議，選擇個案最適宜的溝通方式進行引導，陪著個案與家屬走過一段有意義的幽谷，讓個案與家屬無憾的了解生死兩相安的人生課題，藉此安寧個案照護經驗作為日後照顧此類個案的參考。

This article explores the hospice nursing care experience for an end-stage oral cancer patient who happens to be also a geriatric case. He had limited interaction with family because of work. While facing worsening physical illness of cancer, he did not want to share the news for fear of burdening his family. He later felt he had failed his family and wanted to make up to them, and that motivated the author to explore the situation. The caring period was from August 19 to 26, 2013. Data were collected by means of physical evaluation, medical record review, observation, listening, and talks; data were evaluated in the physical, psychological, social and spiritual aspects for the assessment of holistic health. The major health problems we found were pain, impaired tissue integrity and anticipatory grief. Through the mutual trust and the family relationship, and with the use of the hospice concepts of the whole person, whole family, whole course, and whole team, we provided everyone the measures of care for relieving pain and odor from the tumor-related mushroom-shaped ulcer wound. Furthermore, the patient became willing to actively participate in the wound care. By offering companionship and caring, we ease the patient and the family of the anticipatory grief; we also help them understand the meaning and value of life, how to maintain quality and dignity of life, and finally, approaching the end of life. There is a limit to what a clinical nurse alone could do in guiding the patient and family in dealing with the grief and hospice care. Therefore, we suggest collaboration of teams of hospice to organize family meetings for proper communications and appropriate care channels. That way we could accompany the patient and family through a valley of meanings where they could understand both peace and tranquility of life as well as the death issue without regret. We hope our experience could provide guidelines for similar care of the future.

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