協助一位肝癌末期個案面對死亡焦慮之護理照護經驗

A Nursing Experience of Caring a Terminal Stage Hepatocellular Carcinoma Patient Suffering from Death Anxiety

10.6537/TJHPC.201803_23(1).06

張雅玲(Ya Ling Chang)；劉岱昕(Dai Sin Liou)；郭詩蒂(Shih Ti Kuo)；黃子明(Tzu Ming Huang)；張賢政(Hsien Cheng Chang)；張元玫(Yuan May Chang)

安寧療護 ； 肝癌末期 ； 死亡焦慮 ； hospice and palliative care ； terminal stage of hepato-cellular carcinoma ； death anxiety

安寧療護雜誌

23卷1期（2018 / 03 / 01）

70 - 84

繁體中文

探討一位肝癌末期病人照護經驗，筆者於2015年11月6日至25日藉由觀察、直接照護、會談及團隊討論方式收集資料，運用全人照護評估-生理、心理、社會靈性模式，分析個案有體液容積過量、低效型呼吸及死亡焦慮等健康問題。照護期間個案有腹水及雙下肢水腫困擾，經由肢體按摩、舒適擺位、飲食衛教及依醫囑使用利尿劑和白蛋白改善症狀；提供低流量氧氣、精油及小風扇使用、協助日常活動，減少體力耗費、依醫囑給予抗生素及止喘藥緩解；因經歷鄰床病友往生而感受死亡如此接近，出現情緒低落、夜夢無法安睡，經筆者深入了解個案生命歷程，提供個別性之社會、心理及靈性照顧，個案在瀕死前以個人意志力硬撐著去探望失智且中風的高齡老母，向母親道謝、道愛與道歉，向弟弟及弟媳道謝和道別，凝聚家人間情感得以善別，心靈平靜得以善終，家人有能量得以善生。最終階段依個案意願在醫院辭世，離世時身旁有案弟及弟媳的陪伴及祝福，安寧團隊在旁陪伴提供個案安適，平順邁向另一趟旅途。

This case report explored the experience of the hospice and palliative care for a patient with terminal stage of hepato-cellular carcinoma. From Nov 6^(th) to Nov 25^(th) 2015, the information of this patient were collected through observation, nursing care providing, interview, and team meetings. Assessed by hoslistic biopsychosocial and spiritual approach, the main nursing diagnoses of this patient were identified as ＂deficient fluid volume＂, ＂ineffective breathing pattern＂, and ＂death anxiety＂. His ascites and bilateral lower limbs edema were improved by body massage, suitable position, diet education, diuretics and albumin. To relieve his shortness of breath, low flow oxygen, aromatherapy, and small fan were applied. His daily activities were assisted to reduce physical burden. Prescribed intravenous antibiotics and oral opioids were also administrated. With the terminal disease, he recognized the desperate death after experiencing the passing away of his roommate. He became depressed, speechless, and sleepless at night. After understanding of his life experience, personalized psychosocial and spiritual care was provided. We helped this patient to spiritedly overcome long travel to visit his old-aged stroke demented mother. He appreciated his mother to give him love. And he apologized to her for having done something. As well as said goodbye to his brother and sister-in-law. This action let his families closer and have a chance to say farewell with each other. Then he felt so peaceful that he can face death. After that his families also got energy to go on a good life. At the end of life, according to the wish of this patient, he passed away in hospital with accompanying and blessing by his brother and sister-in-law. Our hospice and palliative care team members cared him at bed-side and comforted him carefully. He went forward to another journey peacefully and smoothly.

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