照顧一位食道癌病人面對死亡焦慮之護理經驗

Caring for an Esophageal Cancer Patient with Death Anxiety

10.6880/TJON.202112/SP_21.08

鍾雅亘(Ya-Hsuan Chung)；鄭惠蘭(Hui-Lan Cheng)

食道癌 ； 營養不均衡：少於身體需要 ； 口腔黏膜障礙 ； 死亡焦慮 ； esophageal cancer ； imbalanced nutrition: less than body requirements ； oral mucosal disorder ； death anxiety

腫瘤護理雜誌

21卷增訂刊II（2021 / 12 / 01）

95 - 106

繁體中文

照顧一位食道癌病患因空腸造口灌食技巧不正確引發胃腸道症狀困擾，且因化學治療及放射線治療後產生口腔黏膜潰瘍的問題，除了須承受多重症狀困擾之外，加上死亡的威脅造成心理上的恐懼及不安，引發筆者深入探討之動機，護理期間自2019年5月21至6月3日，運用Gordon十一項功能性健康型態評估及查閱病歷、身體評估、觀察及會談收集主客觀資料，確立問題有營養不均衡：少於身體需要、口腔黏膜障礙及死亡焦慮。照護期間提供個別性及整體性的護理措施，與營養師共同擬定採連續性低流速空腸灌食計畫、製作灌食流程簡易圖卡，錄製灌食步驟影片，有效改善營養問題；擬訂個別性口腔清潔步驟、擬真模型回覆示教及錄製口腔清潔步驟影片，有效改善口腔潰瘍及異味問題；藉由主動關懷、陪伴、傾聽及安寧醫療團隊和宗教師等介入，引導個案表達內心對於死亡的感受、運用放鬆技巧減緩焦慮情緒，促使其坦然面對，增加死亡準備度。建議在職教育訓練課程中能增加死亡焦慮及情緒輔導的課程，以利有效協助病患調適即將面臨死亡威脅所產生的焦慮，另醫療團隊應及早解釋疾病可能面臨之風險，共同為生死兩相安的目標而努力，提升照護品質。

The author took care of a patient with esophageal cancer suffering from symptom distress induced by incorrect jejunostomy feeding skill. The patient also suffered from oral mucosal ulcers after chemotherapy and radiotherapy. In addition to dealing with the multiple symptom distress, the patient also had to face the psychological fear and anxiety caused by the menace of death, which triggered the author's motivation to perform the in-depth investigations. The nursing care period was from May 21 to June 3, 2019, this study used Gordon's 11 Functional Health Patterns Assessment, chart review, physical evaluation, observations, and interviews to collect subjective and objective data, and confirmed the patient's health problems: imbalanced nutrition: nutritional supplement less than body requirements, oral mucosal disorder, and death anxiety. During the care period, the author provided individualized and holistic nursing measures, worked with nutritionists to develop a slow-drip jejunal feeding schedule, made a simple chart of the feeding process, and recorded videos of feeding steps to effectively address the nutrient deficiency. The author developed personalized oral cleaning steps, demonstrated the teaching model, and recorded oral cleaning steps videos to effectively improve oral ulcers and odor problems. The author offered genuine concerns, companionship, compassionate listening, and intervention from the palliative care medical team and religious counseling, etc., to guide the patient to express the inner feelings about death, use relaxation skills to reduce anxiety, which encouraged the patient to face death gracefully and increase the patient's preparedness for death. It is recommended to include the courses of death anxiety and emotional counseling in the in-service educational training program to help effectively assist patients in managing the death anxiety. Moreover, the medical teams should explain the possible risks of the disease as early as possible and work together with the patients to gain peace for both the living and the deceased while delivering quality care.

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