陪伴一位初診斷末期胰臟癌病患善終之護理經驗

Caring for a Patient Newly Diagnosed with Terminal Pancreatic Cancer

10.6880/TJON.201903/SP_19.05

康佳雯(Chia-Wen Kang)

胰臟癌 ； 緩和醫療照護 ； 無望感 ； 預期性哀傷 ； pancreatic cancer ； palliative care ； hopelessness ； anticipatory grief

腫瘤護理雜誌

19卷增訂刊（2019 / 03 / 01）

53 - 63

繁體中文

本文探討一位初診斷胰臟癌即為癌末之病患，除了承受疾病所帶來的多種身體不適痛苦外，同時面對死亡將近之衝擊，產生嚴重無望感之護理經驗。護理期間2015年10月2日至16日，採生理、心理、社會與靈性發展評估個案及運用直接照護、觀察、傾聽、陪伴、會談等資料收集，個案因胰臟癌合併肝轉移，導致症狀有疼痛、初罹癌情緒低落無望感及家屬預期性哀傷等護理問題。疼痛採藥物、熱敷及按摩，無望感及預期性哀傷，藉由建立關懷、陪伴與同理的人際關係使個案感受溫暖，強化因應及決策能力，照護期間與安寧共同照護團隊合作，藉由共同參與及陪伴癌末到臨終過程，使個案及家屬瞭解癌末生理症狀，體認彼此對治療期待與疾病現況的落差，多次跨團隊會議引導哀傷不捨感受表達，最後在病患臨終階段，未遭遇無效性急救措施，能接受癌末安寧照顧達善終經驗，期望此照護經驗能供日後類似個案護理之參考。

The report describes a patient with newly diagnosed pancreatic cancer who had suffered from the news of the diagnosis and disease-related physical distress. She also encountered the emotional impact of imminent death and fell in severe despair. Comprehensive nursing assessment and intervention were provided by the nursing staff to ease her suffering. From October 2 to October 16, 2015, a multifaceted evaluation to assess the physiological, psychological, social and spiritual aspects of the patient was conducted via direct patient care and a variety of communication methods including observing, listening, accompanying and constructive conversation. In short, the patient had bad pain in her abdomen associated with cancer invasion to abdominal splanchnic nerves and liver metastases, which left the lower limb swelling from proximal deep vein thrombosis. Faced with the declining functional capability and end-of-life issues, the patient began to experience low mood, hopelessness and anticipatory grief. Non-medical treatments, e.g., heat pads and massages, along with pain medicines were used to treat cancer pain and improve quality of life and sleep. Deep vein thrombosis was managed with anticoagulants, analgesics, leg elevation and mobilization in order to lessen the symptoms and increase patient self-care ability. Through personalized nursing care and a caring, sympathetic and respectful relationship with the patient, patient's despair and grief were lifted and she could make her own responsible decisions. We also worked with the patient, her family, hospice team and attending physicians to help patient/family realize and accept disease process and physical changes, to mediate patient-family conflicts and to create an end-of-life plan. In the end, the patient had a good death without futile medical procedures. Hopefully, by sharing this experience, we could help other nursing staff and students in improving their care of end-of-life cancer patients.

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