運用安寧療護於一位肺癌末期患者臨終之照護經驗

Hospice and Palliative Care for a Terminal Lung Cancer Patient

10.6880/TJON.202212_22(2).06

蔡素娟(Su-Chuan Tsai)；洪意華(Yi-Hua Hung)

安寧療護 ； 呼吸困難 ； 慢性疼痛 ； 預期性哀傷 ； 死亡焦慮 ； palliative care ； dyspnea ； chronic pain ； anticipatory grief ； death anxiety

腫瘤護理雜誌

22卷2期（2022 / 12 / 01）

77 - 87

英文

本文描述一位35歲在生產後不久即診斷出肺癌末期合併多處轉移與肋膜積水的患者，期間積極治療仍持續惡化，於生命的末期飽受各種生理症狀、心理及靈性上的煎熬，引發筆者探討的動機。護理期間為2018年10月12日至2018年10月22日。筆者運用Gorden十一項健康功能型態評估工具，並藉由觀察、會談、身體評估及查閱病歷等方式收集資料，並歸納出病人有呼吸困難、慢性疼痛、預期性哀傷及死亡焦慮等健康問題。在照護過程中，結合安寧療護及跨領域團隊合作模式，使用藥物、非藥物之止痛方式及放鬆技巧來減輕疼痛、緩解呼吸喘之不適症狀，並藉由家庭討論會鼓勵病人說出未完成的心願，透過陪伴與支持，引導病人及家屬說出內心真實感受，協助病人及家屬相互道愛及道謝，抒發面臨生命末期所帶來的傷慟，以正向的態度面對即將死亡的事實，共同完成未了的心願與遺憾，並做好臨終準備，以達到善終。

This article describes the nursing experience of caring for a 35-year-old female patient who was diagnosed with terminal lung cancer with multiple metastases and complicated pleural effusion after giving birth to her child. Although she actively participated in the treatment, her condition still got worse afterwards. What motivated the author to further explore her story was her battle against the physical and psychological torture from the illness at the very end of her life. During the nursing period of October 12th to 22nd in 2018, the author applied Gordon's 11 Function Health Patterns as the assessment tool to review the medical record; she also collected data through interviews, observation, and physical assessment. Health issues such as dyspnea, chronic pain, anticipatory grief, and death anxiety were identified. Palliative care combined with interdisciplinary team work were implemented. The patient received pharmacological and non-pharmacological analgesia as well as relaxation techniques to relieve her discomforts. The patient and her family were encouraged to speak about their true feelings through family meetings and to express their love and gratitude toward one another. This way, they could express their grief for their imminent loss and further keep a positive attitude towards death. With the support and companionship of her family, the patient was able to face the end of her life and ultimately achieved a good death.

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