運用Swanson關懷理論照護一位大腸癌末期個案之護理經驗

The Nursing Experience of Caring the Case who was Newly Diagnosed Metastatic Colon Cancer with Swanson Care Theory

10.6880/TJON.202406_24(1).06

翁瑋彤(Wei-Tung Weng)；蕭孟蘋(Meng-Ping Hsiao)；張馨元(Sin-Yuan Jhang)

大腸癌 ； Swanson關懷理論 ； 安寧緩和照護 ； colorectal cancer ； swanson care theory ； hospice and palliative care

腫瘤護理雜誌

24卷1期（2024 / 06 / 01）

67 - 77

繁體中文;英文

本文為一位初診斷即轉移性大腸癌個案，接受安寧緩和照護到善終的護理經驗。護理期間自2021年8月17日至9月2日，以觀察、身體評估、會談、家屬訪談及病歷查閱方式收集資料，運用生理、心理、社會與靈性四大層面進行整體性護理評估，確立「低效性呼吸型態」、「增進心靈安適的準備度」、「預期性哀傷」為主要健康問題。護理過程使用風扇低速吹向臉頰，以緩解呼吸喘；應用Swanson關懷理論，以跨團隊（心理師、安寧共照護理師、呼吸治療師等）建立與個案及案家護病關係，協助了解末期症狀進展，並引導個案及案家行四道人生，減緩即將與親人永別所致的哀傷並共同完成個案返家心願，達成生死兩相安的善終目標。建議能增加跨團隊之安寧緩和案例討論，強化外科護理師之安寧照護技巧；最後，期許此個案照護經驗能供護理人員照護之參考。

This case report describes the nursing experience in caring for the patient who was newly diagnosed metastatic colon cancer and treated with hospice palliative care to end well. The nursing care was implemented from August 17 to September 2, 2021. After many times family meeting, the patient signed the Do Not Resuscitate (DNR) form. However, the severe respiratory symptom, spiritual distress, and the strong grief of the family, which motivated the author to write this article. The materials were collected through observations, physical examinations, interviews of the patient and his family, and reviewing his medical record. The overall nursing assessment was conducted using the four major levels of physiological, psychological, social, and spiritual aspects. After that, the author confirmed the health problems: "ineffective breathing pattern", "readiness for enhanced spiritual well-being", and "anticipatory grieving" are the main nursing issues. The nursing process has been blowing at low speed to the cheek to chin area with a fan, and using Swanson Care Theory with interprofessional collaborative practice (psychologists, hospice care nurses, and respiratory therapists… etc.) not only to build the good relationship between medical team and patient but also help them understanding the progress of terminal illness. Then, it can also provide the emotional and spiritual support to the family. It's a good way to help them dealing with the grief of losing a family member, fulfill his wish that he wants to go back home. Through fulfilling the four principles of life (to express love, gratitude, forgiveness, and grace in bidding farewell), we can achieve ending well for both living and death. We hope to strengthen hospice caring skill of nurses in surgery department by holding seminars with interprofessional collaborative through more hospice palliative cases. Last but not least, we hope that sharing this caring experience can provide the helpful reference for nursing care about terminal illness patients or hospice palliative care in the future.