照護一位肌萎縮性側索硬化症末期病人之安寧護理經驗

Nursing Care Experience of an End-stage Amyotrophic Lateral Sclerosis Patient

10.6537/TJHPC.202009_24(3).04

韓榮欣(Jung-Hsin Han)；謝依靜(Yi-Ching Hsieh)；賴亭伃(Ting-Yu Lai)；曾斐琳(Fei-Lin Tseng)

安寧療護 ； 肌萎縮性側索硬化症 ； 末期病人照護 ； hospice care ； amyotrophic lateral sclerosis ； end-of-life care (EoLC)

安寧療護雜誌

24卷3期（2020 / 09 / 01）

240 - 251

繁體中文

本文描述運用安寧療護照護一位肌萎縮性側索硬化症末期病人之護理經驗。護理期間自2018年5月18日至5月23日，以個案為中心，運用會談、唇形、溝通圖卡溝通及直接護理等非語言及關懷方法，予以收集個案生理、心理、社會及靈性等層面資料，確認個案有舒適障礙、無效性呼吸道清除功能及哀傷之健康問題。以安寧療護理念提供個別性舒適照護，如口腔護理、芳香療法及按摩，床上沐浴以維護身體清潔，利用胸腔扣擊及抽痰維持呼吸道通暢，緩解個案身體舒適障礙，藉由宗教信仰，協助個案進行生命回顧以降低哀傷，使個案的生活品質提升及尊嚴平安，並期望達到安適善終之護理目標。期望此照護經驗可提供護理人員對日後此類病人之參考，以協助個案能夠平安的善終，使家屬能坦然面對個案死亡以達善別、善終，並落實安寧療護以全人、全家、全程、全隊之四全照顧。

This article describes the experience of applying hospice care for a patient with end-stage amyotrophic lateral sclerosis. During the period between 18th and 23rd May 2018, various methods such as conversation, lip-reading, graphic communication, direct care, and non-verbal caring practices were all utilized to collect information on the physical, psychological, social, and spiritual wellbeing of the patient. It was vital to identify if the patient had any health problems such as discomfort, ineffective respiratory clearance, or grief. The principles of palliative care aim to provide individualized comfort care, such as oral care, aromatherapy, massage, and bed baths to maintain body cleanliness. Chest clapping and sputum suction were used to clear and maintain the patient's respiratory tract to alleviate discomfort. To reduce grief, improve quality of life, and enhance self-dignity and peace, talks of religious and spiritual beliefs were used to help the patient to do a life review to achieve the goal of a peaceful, comfortable death. It is hoped this caring experience can serve as a reference for future nurses with similar patients in aims to help those patients pass away peacefully. The implementation of palliative care for the patient enabled the family to come to terms with the patient's death bringing about a peaceful ending with a happy goodbye, making it smoother for the patient, the family, the process, and the whole team.

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