一位獨居肝癌末期病人進行善終準備之護理經驗

Nursing Experience of Good Death Preparation to a Living Alone Patient with Terminal Stage Hepatocellular Carcinoma

10.6647/CN.202312_30(4).0009

王湘芸(Hsiang-Yun Wang)；林鳳蓮(Feng-Lien Lin)；邱鈺佩(Yu-Pei Chiou)

肝癌末期 ； 善終 ； 疼痛 ； 焦慮 ； 照顧者 ； terminal hepatoma ； good death ； pain ； anxiety ； caregiver

彰化護理

30卷4期（2023 / 12 / 01）

82 - 93

繁體中文;英文

本文係描述一名60歲患有肝癌的緬甸華僑個案在反覆入院後，接受生命末期進行善終準備之護理過程。早期個案撤僑返臺過程中藉由另類管道回到臺灣，導致與現住臺灣家屬無法律上的親屬關係，面對生命消逝及害怕無人協助善終準備感焦慮。家屬面對個案突如其來病情變化感到震驚，並且在法律上對個案遺體及遺囑的後續處理陷入瓶頸。護理期間為2020年12月11日至2020年12月25日，經由會談、身體評估、觀察及病歷查閱收集資料。以Gordon 11項功能性健康型態進行護理評估，確立個案健康問題為疼痛、焦慮及照顧者角色緊張。針對上述健康問題提供個別性護理指導，以冥想和聆聽喜愛的音樂轉移對疼痛的注意力，同時傾聽及引導個案主動表達內心感受及焦慮，由安寧共照護理師、社工師、出院規劃小組護理師共同照護，提供資源緩解個案的焦慮及家屬緊張，使其能交代遺囑並完成註記安寧緩和意願書，對善終準備執行完成感到安心無牽掛。建議護理師可多接受安寧照護課程及對無法律關係親屬之因應方式，以提供個案更完善的善終照護，期望藉此護理經驗，提供護理師及日後照顧此類個案之參考。

The report described the end-of-life nursing for a 60-year-old Chinese overseas in Burma who sustained terminal hepatoma and had been repetitively hospitalized. Since the patient previously returned to Taiwan via alternative access, the kinship with Taiwanese relatives was considered invalid. The patient was therefore anxious about facing death and funeral arrangements. Family members were not only too surprised to accept the abrupt downhill of illness but also difficult to deal with the disposal of remains and testament. The nursing care was executed during December 11th, 2020 to December 25th, 2020. The information was collected through interviews, physical evaluation, observation, and medical record. By employing Gordon's 11 Health Functional Patterns, health issues of the subject was identified as physical pain, anxiety, and excessive burden for caregiver roles. To implement an individualized nursing guide, following measures were attempted including pain relief by medications and music, guidance for emotional expression, and incorporation of hospice team nurse as well as social worker. Social resources and potential reimbursements were offered to patient and family. Eventually, the patient was able to realize his willingness by signing consent form of Hospice Palliative Care to prepare for good death at ease. Through the nursing if this patient, we highlighted the significance of literacy upon hospice care and proper response to families without legal relationship. We also demonstrated a paradigm for future nursing upon such population.

1. 胡彥佶,李癸汌(2018)。肝硬化反覆性腹水的藥物治療。臨床醫學月刊，82(6)，749-756。
   連結：
2. 徐雯娟,林瑞香,林梅香,徐秀琹,石惠美(2019)。肝硬化病人主要照顧者之生活品質及其相關因素。護理雜誌，66(1)，60-69。
   連結：
3. 高以信,劉耀庭,柯美伶,蘇盈惠,魏美琴,江瑞坤(2016)。探討癌末病人接受居家安寧療護後在宅善終的相關因子。安寧療護雜誌，21(2)，141-153。
   連結：
4. Deng, G.(2019).Integrative medicine therapies for pain management in cancer patients.Cancer journal,25(5),343-348.
5. Forner, A.,Reig, M.,Bruix, J.(2018).Hepatocellular carcinoma.The Lancet,391(10127),1301-1314.
6. Garza-Villarrea, E. A.,Pando, V.,Vuust, P.,Parsons, C.(2017).Music-induced analgesia in chronic pain conditions: A systematic review and meta-analysis.Pain Physician Journal,20(7),597-610.
7. Kastbom, L.,Milberg, A.,Karlsson, M.(2017).A good death from the perspective of palliative cancer patients.Supportive Care in Cancer,25(3),933-939.
8. Lourenço, T. M. G.,Abreu-Figueiredo, R. M. S.,Sá, L. O. D.(2020).Review of nursing diagnosis validation studies: Caregiver role strain.Revista Gaúcha de Enfermagem,41,e20190370.
9. Mintz, K. J.,Leblanc, R. M.(2021).The use of nanotechnology to combat liver cancer: Progress and perspectives.Biochimica et biophysica acta - Reviews on cancer,1876(2),188621.
10. World Health Organization. (2021). Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer
11. 徐友春(2017)。認識肝癌及肝硬化。血管醫學防治季刊，28，8-9。
12. 劉作揖(2017)。談遺囑的預立與遺囑的執行。中華禮儀，37，37-42。
13. 衛生福利部統計處（2020，9月7日）．108年統計死因年報．https://dep.mohw.gov.tw/dos/cp-4927-55571-113.html