一位子宮惡性肉瘤末期病人接受安寧共同照護之護理經驗

A Hospice Combined Care Experience for an End-Stage Uterine Carcinosarcoma Patient

10.3966/168395442017061701005

林彥姍(Yan-Shan Lin)；張煦婕(Hsu-Chieh Chang)；施秀鈴(Hsiu-Ling Shih)；潘雪幸(Hsueh-Hsing Pan)

子宮惡性肉瘤 ； 安寧共同照護 ； 善終 ； uterine carcinosarcoma ； hospice combined care ； good death

腫瘤護理雜誌

17卷1期（2017 / 06 / 01）

49 - 62

繁體中文

本文為一位子宮惡性肉瘤末期病人接受安寧共同照護之護理經驗，個案因子宮惡性肉瘤末期出現疼痛、呼吸困難、死亡恐懼等問題，且因病人年輕，曾陳述對自己病況急速下滑感到恐懼與害怕，無法陪伴母親盡孝道深感愧疚，故引發筆者探討的動機。護理期間自2014年8月15日至8月25日，運用身體、心理、社會、靈性整體評估方式收集資料，發現個案有慢性疼痛、低效性呼吸型態、死亡恐懼等問題。照護過程中，運用傾聽、關懷、陪伴及鴉片類、鎮靜藥物與治療性觸摸、按摩、舒適臥位、經皮神經電刺激、音樂治療等非藥物方法，緩解病人疼痛與呼吸困難症狀；運用安寧療護的「四全理念」與安寧共同照護團隊合作的方式，透過生命回顧，鼓勵家屬與個案表達情感以及對生命意義的肯定，並協助個案與家屬互訴四道人生，使雙方都達到身體、心理、社會、靈性的平安，緩解個案的死亡恐懼。建議院方增加死亡議題的溝通技巧以及照護技能的在職教育，讓護理師更具備專業知識、技能及勇氣，處理末期病人的死亡恐懼；並建議照護末期病人時，可透過安寧共同照護團隊進行跨領域合作，提供更多元化之照護，並推廣安寧緩和療護理念，以提升更優質的護理服務。

This article describes the nursing experience of applying hospice combined care to a uterine carcinosarcoma patient at the terminal stage. The patient suffered from cancer pain, dyspnea and fear of death in the terminal stage. She had stated that she felt much fear from her fast declining condition and terrible guilt for not spending more time with her mother. The caring period was from August 15 to 25, 2014. By way of holistic health assessment in the physical, psychological, social and spiritual aspects, we found the patient had encountered chronic pain, ineffective breathing pattern, and fear of death. During the caring process, we implemented various techniques to help manage patient's pain and dyspnea by listening, showing empathy, and accompanying as well as non- medical practices such as therapeutic touch, massages, transcutaneous electric nerve stimulation (TENS) and music therapy. Through hospice combined care using life reflection, we encouraged family members and patient to express their emotions about life and to affirm the meaning of life. We also helped patient and her family members to express love, show gratitude, make amend and say goodbye with one another. It made them feel peace in physical, psychological, social, and spiritual ways and it also lifted the fear of death of the patient. For the nursing staff to take better care of the terminal stage patients, we suggest that the hospital could provide education on how to communicate the subject of death and also how to handle the patient's fear of death. We could ask hospice combined care team members for interdisciplinary collaboration to provide more diverse and high quality nursing care.

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