照護一位肺癌末期獨居長者之安寧居家療護善終之護理經驗

The Home-Based Hospice Pailliative Care Experience of an Elderly Patient with Terminal Lung Cancer Living Alone

10.6880/TJON.202306_23(1).09

鄧淯勻(Yu-Yun Den)；楊曜蓮(Yao-Lian Yang)；葉惠玲(Hui-Ling Yeh)

肺癌末期 ； 安寧居家療護 ； 遠端照護 ； 在宅善終 ； End-of-life ； Lung cancer ； Home-based hospice care ； Telemedicine ； Good death at home

腫瘤護理雜誌

23卷1期（2023 / 06 / 01）

103 - 113

繁體中文;英文

本篇是一位90歲高齡獨居女性、肺癌末期併對側肺轉移，因期望在宅善終，採用安寧居家照護模式結合遠端科技照護之護理經驗。護理期間自2019年11月12日至11月28日，共6次居家訪視，每次實地居家訪視時間約50－90分鐘，每次訪視運用生理、心理、靈性及社會層面整體性評估，並經由觀察、會談、身體評估、電訪及手機視訊等方式收集資料，確立個案有呼吸困難、潛在危險性傷害、心靈困擾之健康問題。故提供製氧機、嗎啡類藥物減輕個案呼吸困難症狀，改善臨終呼吸喘及喉頭音；因個案獨居，故護理過程中協助連結社區長照資源、結合遠端科技運用通訊軟體與醫護端即時溝通處理症狀，減輕家屬照護壓力、降低獨居傷害風險。照護期間個案尋求在宅善終，故予陪伴傾聽，引導個案生命回顧，說出善終意願，並召開家庭會議，協助案家達成共識，透過即時通訊軟體及臨終症狀衛教準備，降低家屬焦慮及照護不確定感，讓個案享有最大自主權，有尊嚴的離世，圓滿在宅善終心願。

This article presents a 90-year-old female terminal lung cancer patient with contralateral metastases. She experienced peaceful at-home hospice care combined with remote care during the nursing care from November 12 to November 28, 2019. There were six home visits, each for about 50-90 minutes. The assessment tool of the hospice care was employed to evaluate the patient's physiological, psychological, spiritual, and social status. Data was collected through observations, face-to-face interviews, physical assessments, telephone interviews, and video chat. The patient's problems identified were dyspnea, potential risk of injury, and spiritual distress. Therefore, the oxygen generator and morphine drugs were provided to reduce dyspnea and stridor. As the patient was living alone, there were many tasks to be done, including connecting the community's long-term care resources, combining home and remote care, communication software for immediate assistance to relieve symptoms during the nursing process, and improved family caregiving burden. As the patient was expecting to die at home, there was a need for companions to listen to her and guide her. We held family meetings to discuss end-of-life management to reduce anxieties and sense of uncertainties. There was a need for respect for the autonomy of the patient to help fulfill her wish of living in the house and leaving the world with dignity.

1. 黃文翰,鄭逸如,楊于婷,張琦郁,黃士哲(2017)。如何面對臨終的死亡焦慮－誰該為自身的死亡負責？。安寧療護雜誌，22(2)，202-212。
   連結：
2. 黃詩凌,賴維淑,方素瓔(2018)。運用風扇緩解呼吸困難－系統性文獻回顧與臨床應用。護理雜誌，65(4)，84-93。
   連結：
3. Chi, N. C.,Demiris, G.(2015).A systematic review of telehealth tools and interventions to support family caregivers.Journal of Telemedicine and Telecare,21(1),37-44.
4. Connolly, M.,Timmins, F.(2021).Spiritual care for individuals with cancer: The importance of life review as a tool for promoting spiritual well-being.Seminars in Oncology Nursing,37(5),151209.
5. Lim, R. B.(2016).End-of-life care in patients with advanced lung cancer.Therapeutic Advances in Respiratory Disease,10(5),455-467.
6. Morris, S. M.,King, C.,Turner, M.,Payne, S.(2015).Family carers providing support to a person dying in the home setting: A narrative literature review.Palliative Medicine,29(6),487-495.
7. 王思雅(2016)。長期照護體系下的安寧居家療護。社區發展季刊，153，170-181。
8. 周慧琍（校閱）(2018).臨終與生死關懷.華杏.
9. 郭巧雯,黃露萩,方文熙,劉翠瑤,游麗瑾,馮容莊(2018)。護理人員對家庭會議的態度與行為。北市醫學雜誌，15(1)，78-90。
10. 陳伶珠,蔡旻珮(2017)。獨居老人緊急救援服務輸送模式與社會工作角色功能－以某社福組織為例。台灣社區工作與社區研究學刊，7(1)，1-32。
11. 劉家勇(2015)。社區獨居老人社會照顧模式之研究：以台灣及日本在宅服務方案為例。台灣社區工作與社區研究學刊，5(2)，49-99。
12. 蔡孟修,柯獻欽(2017)。末期肺癌患者之安寧療護。內科學誌，28(6)，325-333。
13. 衛生福利部（2020，6月16日）．108年國人死因統計結果。https://www.mohw.gov.tw/cp-16-54482-1.html。