運用安寧療護理念於一位肝癌末期病人之護理經驗

The Concept of Hospice Care for a Terminal Liver Cancer Patient: A Nursing Experience

10.6880/TJON.202206_22(1).10

莊書蓉(Shu-Jung Chuang)；黃麗娟(Li-Chun Huang)；宋聖芬(Sheng-Fen Sung)

肝癌 ； 安寧療護 ； 死亡焦慮 ； hepatocellular carcinoma ； palliative care ； death anxiety

腫瘤護理雜誌

22卷1期（2022 / 06 / 01）

125 - 137

繁體中文

本文描述一位運用安寧療護理念於肝癌末期患者，入院後接受化學治療，但病情持續惡化，導致須面對死亡焦慮之護理經驗。筆者於2018年12月5日至2019年2月8日護理期間，運用Gordon十一項功能性護理評估收集資料，以觀察、會談、身體評估及病歷查閱等方式收集資料，確認個案有低效性呼吸型態、慢性疼痛、潛在危險性感染及死亡焦慮等健康問題。筆者在護理過程中給予高氧氣濃度、使用小風扇等方法緩解呼吸不適；與個案討論非藥物之疼痛緩解方法，如精油按摩、音樂治療、深呼吸、撫摸治療及舒適臥位來減緩疼痛；衛教個案及家屬管路照護及預防感染，協助個案減輕疾病導致生理的不適。經與個案及家屬共同擬訂具個別性及整體性之護理計畫，了解個案心中擔心放不下的事情，透由安寧療護之生命回顧與靈性安適，讓個案面對即將死亡事實，體會生命意義，陪伴走出死蔭的幽谷。期望藉由此護理經驗之分享能夠提供護理同仁往後照護類似個案之參考。

This study describes and discusses the experience of caring for an advanced liver cancer patient using palliative care. The patient underwent chemotherapy upon admission to the hospital, but the condition worsened, leading to the death anxiety. During the nursing care form December 5, 2018 to February 8, 2019, the author assessed the patient using the Gordon's 11 functional health patterns, through observation, conversation, and medical record review. The major health problems of the patient included ineffective breathing pattern, chronic pain, high infection risk, and death anxiety. During the nursing period, we provided the small fan and high concentration oxygen to mitigate breathing difficulties. The visual analog scale was used to assess the chronic pain, and through essential oil massage, music therapy, deep breath, gentle caress therapy and comfortable lying position to reduce pain. We also performed the health education of catheter care, wound care, and infection prevention. We utilized life review, interpersonal relationships, and spiritual comfort to relieve patient's death anxiety. Finally, the patient can face death peacefully, understand the meaning of life, share the worriment in mind, and come out of the dismal. We hope to share this nursing care experience with the nursing staffs as a reference for similar situations.

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