一位肝癌末期病人無望感之照護經驗

The Experience of Nursing Care for a Disheartened Patient with Terminal Hepatocellular Carcinoma

10.6880/TJON.201812_18(2).07

林家溱(Chia-Chen Lin)；侯宥如(You-Ru Hou)

肝癌末期 ； 皮膚搔癢 ； 陰囊水腫 ； terminal-stage of hepatocellular carcinoma ； skin itching ； hydrocele testis

腫瘤護理雜誌

18卷2期（2018 / 12 / 01）

73 - 84

繁體中文

本文探討一位67歲肝癌末期病人，母親及兩位兄長皆因肝癌相繼去世，本身疾病不斷惡化而產生無望感之照護過程。護理期間為2015年4月23日至2015年5月29日，運用Gordon十一項功能性健康型態評估模式進行整體性評估，透過觀察、會談、身體評估、直接照護及團隊討論等方式收集資料，確認個案主要健康問題：體液容積過量、皮膚嚴重搔癢、家庭對個案情況與後事的溝通阻礙。護理過程中，藉由淋巴按摩改善下肢淋巴水腫、冷水水球減緩陰囊水腫的脹熱不適感、使用含尿素成份藥膏加強皮膚保濕來止癢等舒適護理，減輕個案生理上的不適；以同理心、尊重的態度與個案及家屬建立治療性關係，給予陪伴、關懷、傾聽，透過分開會談及居中溝通的方式，鼓勵個案與家屬互相表達、傾聽彼此的擔憂及對未來生活的安排，使其心理及靈性層面獲得平靜與滿足。文獻回顧中，鮮少有針對肝癌病人且兼具癌症家族史之心理照護技能之文獻參考，為此護理過程之困擾。期望此次護理經驗能提供照護癌症末期病人之臨床人員參考。

This is a study about the nursing course of a terminal liver cancer patient, whose mother and brothers passed away from the same disease. He felt discouraged because of the disease progression. During the period from April 23 to May 29, 2015, according to the ＂Gordon's 11 Function Health Patterns＂ system, the data were collected through observation, conversations, physical examination, direct patient care, and team conferences. The patient's health problems were identified as the fluid retetion, skin pruritis, and family communication obstacle. During the period of nursing care, patient was given several methods to lessen discomfort and they were: (1) improving the peripheral edema with lymphatic massage of the etremities, (2) decreasing the discomfort from swellign scrotum with cold therapy, (3) easing skin itch with the urea cream. We nurtured the sense of empathy and respect with family and patient for better rapport in nursing care. We also focused on company, listening, and special care. By way of private and itervention talks about the major problems between family and patient, we built a better relationship for sharing the spiritual insight and the plans to the future. Our purpose is the peace of mind and wellbeing of the physiological and psychological health of the patient and family. Reviewing the previous studies, we saw few researchs assessing the mental health of patients like ours – one who has liver cancer with a family history of cancers. We hope this study can shed light on future nursing care improvement for the terminal liver cancer patients.

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