運用靈性照護協助一位突發心臟衰竭合併淋巴癌個案平安走向死亡之護理經驗

A Nursing Experience of the use of Spiritual Care for a Patient Dying in Peace with Acute Onset of Heart Failure and Lymphoma

10.6537/TJHPC.202003_24(1).05

李昕悅(Hsin-Yueh Lee)；張婉慈(Wan-Tzu Chang)；蘇淑貞(Shu-Chen Su)；陳幸眉(Hsing-Mei Chen)

心臟衰竭 ； 淋巴癌 ； 靈性照護 ； 死亡接受 ； heart failure ； lymphoma ； spiritual care ； death acceptance

安寧療護雜誌

24卷1期（2020 / 03 / 01）

59 - 71

繁體中文

本文敘述一位短時間內被診斷嚴重心臟衰竭合併淋巴癌個案的照護過程，個案因心臟功能急速惡化，導致體液容積過量而出現呼吸困難，面對突然的死亡威脅，拒絕可延長生命的侵入性治療，透過每日照護與其建立信任關係，整體評估後確立個案有「呼吸困難」、「活動無耐力」、「家庭因應能力失調」及「逃避性接受死亡」等問題。本文呈現以緩解呼吸困難為首要護理目標之護理過程，並將靈性照護四階段「了解、同理、指引、成長」融入每日的照護過程中，協助個案修復與「天、人、物、我」四個靈性本質之間的關係，引導其重新定義生命的意義及價值，最終修復與家人的關係，完成四道人生「道謝、道歉、道愛、道別」，並中性的接受死亡。

This article describes the caring experience for a patient who received the diagnosis of severe heart failure and lymphoma within a short time. His heart function was deteriorated quickly, leading to body fluid overload and dyspnea. Suddenly facing the death threat, he refused all of the invasively lifesaving procedures, rather quickly accepted the fact of dying. After building a trustful rapport with the patient and his families through the daily routine care, in-depth assessments were carried out, and four urgent health problems were identified; ＂impaired cardiac tissue perfusion＂, ＂dyspnea＂, ＂activity intolerance＂, ＂ineffective family coping＂, and ＂escape acceptance of death＂. This paper presents the nursing process of ameliorating his dyspnea as the first priority of nursing outcome and applied a four-step strategy of spiritual care including ＂understanding, empathizing, guiding, and growing＂ to the routine care activities to help him reconstruct the relationships with the four constitutive patterns of spirituality including ＂God, objects, others, and id.＂ We also guided him to redefine the meaning and value of his life. Finally, the patient successfully repaired his relationship with the families, truly accepted his death, and fulfilled the four principles of life: gratitude, forgiveness, love, and grace in bidding farewell.

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