結合安寧共同照護一位食道癌末期病人護理經驗

The Nursing Experience of a Terminal Esophageal Cancer Patient on Hospice and Palliative Care

10.6880/TJON.202212_22(2).07

王夢筑(Meng-Jhu Wang)；鄭幸蓉(Hsing-Jung Cheng)；李紫綺(Tzu-Chi Li)

食道癌 ； 末期疾病 ； 安寧共同照護 ； 居家靜脈營養 ； esophageal cancer ； terminal disease ； hospice and palliative care ； home parenteral nutrition

腫瘤護理雜誌

22卷2期（2022 / 12 / 01）

89 - 102

英文

本文描述一位食道癌末期中年男性，因面對疾病無法治癒，對未來感到無望，同時表達出想返家的心願，故引發筆者探討動機，護理期間為2019年5月9日至6月1日，運用Gordon十一項功能性健康型態，以觀察、會談、翻閱病歷、身體評估及家庭會議等收集方式，發現個案有慢性疼痛、無望感及增進家庭因應能力的準備度等健康問題。透過原醫療團隊與安寧團隊共同合作，經由詳細的疼痛評估，調整止痛藥物及給予音樂治療、精油按摩與舒適臥位，以減輕疼痛；藉由傾聽及關懷陪伴，引導說出心中感受及期許，運用生命回顧及家庭支持力量，幫助個案完成暖親圓夢、表達對家人的愛，重拾生命意義及存在價值，進而增進希望感；透過家庭會議了解家庭處遇與照顧需求，利用視訊評估居家環境，共同研擬居家靜脈營養輸液學習計畫，並錄製教學影片、製作指導手冊及回覆示教確認執行正確性，最後讓個案如願返家，出院後持續電訪追蹤，並安排安寧居家護理師接續照護，使其獲得持續且完整的照護。

This article demonstrates a nursing experience through hospice combined with palliative care for a middle-aged man with terminal esophageal cancer to fulfill his wish to return home. This patient faced an incurable disease and suffered from physical discomfort and hopelessness of life, so he expressed a strong wish to go home rather than staying in the hospital. The above situation triggered the author's motivation to explore the patient's nursing care. The nursing period was from May 9th, 2019 to June 1st, 2019. The Gordon's functional health model was used for the assessment of this patient. The data were collected through observation, consultation, physical examination, chart reviews, and family meetings. The issues identified were pain, sense of hopelessness, and the need to prepare for enhanced family coping. We provided a detailed pain assessment by the original medical team and hospice team, after which we adjusted the pain medications and gave him music therapy and essential oil massage while showing him on how to maintain a comfortable position to reduce the pain. Furthermore, we encouraged the patient to express his feelings and expectations through active listening. We also guided him to fulfill his wishes through family support and life review. We encouraged family members and the patient to express their feelings about life, to approve the meaning of life, and to regain hope of life. We clarified their family needs and care needs through family meetings. We used web camera to assess his home environment and made tailored training plan for home parenteral nutrition execution, which included demonstration videos, instructional manuals and repeated live demonstrations, practice and feedback to reach perfection. At the end, the patient was discharged and went home smoothly. We conducted telephone interviews and arranged home caregiver to monitor the process of home parenteral nutrition and to provide continuous and complete medical care.

1. 曾淑怡(2015)。癌症患者居家靜脈營養照護出院準備。彰化護理，22(3)，17-18。
   連結：
2. 趙可式(2015)。安寧療護是普世價值且為護理的本質。護理雜誌，62(2)，5-12。
   連結：
3. 賴慧文,陳玉紛,蔡育倫,張慕民,潘雪幸(2016)。安寧共照介入對癌末病人安寧療護、安寧共照知識及接受意願之成效。源遠護理，10(2)，33-38。
   連結：
4. Sachs, E.,Kolva, E.,Pessin, H.,Rosenfeld, B.,Breitbart, W.(2013).On sinking and swimming: The dialectic of hope, hopelessness, and acceptance in terminal cancer.American Journal of Hospice and Palliative Medicine,30(2),121-127.
5. Stoner, N. E.,Schiavone, P.,Kinosian, B. P.,Pickett-Blakely, O.,Amoroso, V. K.,Coughlin, R.,Xue, Z.,Compher, C.(2019).Preparing the patient for home parenteral nutrition and for a successful course of therapy.Gastroenterology Clinics of North America,48(4),471-481.
6. 吳孟嬪,馮容莊,黃美齡,何璇,孫文榮,黃勝堅(2019)。建構完善的台北市居家安寧照護模式。北市醫學雜誌，16，134-144。
7. 李昕宜,許玉娟,陳佳慧(2014)。癌症生存者之困擾症狀。台灣醫學，18(3)，355-360。
8. 李鳳瓊,鄭立勤,周來香,蘇秀貞,陳慧娟,楊俊杰(2015)。接受全靜脈營養的成人病患發生中心靜脈導管感染的相關危險因子。臺灣營養學會雜誌，39(3)，88-94。
9. 林泰丞,李隆軍,胡中傑,劉夷生(2017)。類鴉片止痛藥在安寧居家照護運用的選擇。家庭醫學與基礎醫療，32(3)，84-90。
10. 洪曉佩,黃惠美,曾麗華,明金蓮(2015)。護理人員推動無痛醫院的角色。醫院雙月刊，48(3)，48-57。
11. 許玉娟,成佳憲,李章銘,黃培銘,陳佳慧(2016)。食道癌患者於治療期間面臨的困境與其照護策略。台灣醫學，20(6)，634-641。
12. 衛生福利部（2021，6月18日）．109年國人死因統計結果分析。https://www.mohw.gov.tw/cp5017-61533-1.html