一位初次罹患肝癌末期病人面臨靈性困擾的護理經驗

Experience of Caring for a Newly Diagnosis of End Stage Liver Cancer Patient with Spiritual Distress

10.6880/TJON.201911/SP_19.04

鍾芷涵(Jhih-Han Jhong)；陳芝文(Chih Wen-Chen)

肝癌末期 ； 靈性困擾 ； 護理經驗 ； terminal stage hepatocellular carcinoma ； spiritual distress ； nursing experience

腫瘤護理雜誌

19卷增訂刊II（2019 / 11 / 01）

43 - 56

繁體中文

本文為描述一位初次診斷肝癌末期病人的護理經驗，因突如其來的疾病造成疼痛、焦慮、對長期信仰的宗教產生憤怒與不信任，及與妹妹關係破裂而造成靈性困擾。護理期間自2016年10月22日至11月8日，筆者藉由直接照顧、觀察、會談、查閱病歷等方式收集資料，依Gordon十一項健康功能型態進行評估，確認病人有疼痛、焦慮及靈性困擾等三項主要健康問題，筆者於護理過程以病人為中心，建立良好治療性關係、主動關懷、耐心傾聽並了解與同理個案身、心、靈的需求，藉由藥物及物理方式協助緩解疼痛，鼓勵說出心中感受、接納情緒的表達、提供疾病相關資訊並運用懷舊療法緩解焦慮，經由宗教師及教友的陪伴、共同祈禱並由案女協助以生命回顧方式，回想及述說過往開心的事，肯定生命的意義與價值，以恢復原有的禱告習慣，道謝、道愛、道歉及道別來重建姊妹關係。最終，個案表示已了無遺感並順利出院，繼續人生未完成的道路。希望此經驗分享，做為照護個案的參考，以提升護理人員對癌症末期病人靈性照護的敏感度並增進靈性照護品質。

This article describes the experience of nursing a patient who was newly diagnosed with the terminal stage hepatocellular carcinoma. The sudden onset, pain, anxiety, anger, distrust of long-term religious beliefs and the torn relationship with her sister led to spiritual distress. From October 22 to November 8, 2016, through direct care, observation as well as consultation, and review of medical records, the data were collected. Gordon 11 Function Health Patterns were used to evaluate and identify the following major health issues: pain, anxiety, and spiritual distress. The author took on the patient-centered attitude in the nursing process and established a good therapeutic relationship where the author applied proactive care, patiently listened and understood the needs of the physical, psychological, and spiritual aspects of this patient. Patient's pain was lifted through drugs and physical therapy, expression of feelings and acceptance of emotions was encouraged, and educaiton on diseases was given; anxiety was alliviated by using the reminiscence therapy, company of religious teachers and church member praying together to assist the patient in revisiting and describing the positive and happy evnets of the past, to where the patient was able to rethink and reaffirm the meaning and value of life to restore the original prayer habits and rebuild the relationship with her sister by way of praises, love, apologies and goodbyes. The patient was able to achieve pure comfort and harmony in the physical, psychological, and spiritual aspects. Finally, accompanied by family members upon discharge, the patient saw she had lived a life with no regrets and had the peace of mind to continue the unfinished path of life. It is hoped that this experience will be shared as a reference for the care of such patients by improving the sensitivity of nursing staff to the spiritual care of patients with advanced cancer so they can increase the quality of spiritual care.

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