一位結腸癌末期病人之照護經驗

Caring for a Patient with Terminal Stage Colon Cancer

廖名儀(Ming-Yi Liao)

安寧療護 ； 癌症末期 ； 善終 ； Hospice care ； terminal stage cancer ； peaceful death

若瑟醫護雜誌

16卷1期（2022 / 03 / 01）

80 - 91

繁體中文

本文描述一位83歲結腸癌末期男性，因死亡將至對生命感到無望而尋求安樂死，於內科病房經由安寧共同照護護理師介入，以安寧療護照護善終之護理經驗。護理期間自2019年1月5日至2月11日，筆者藉由觀察、會談、身體評估及查閱病歷方式收集資料，對個案的生理、心理、社會、靈性等方面進行整體性護理評估，確認個案有「慢性疼痛」、「無望感」與「心靈困擾」等健康問題。護理過程運用精油及穴位按摩，採舒適臥位達到緩解疼痛；透過陪伴、傾聽及非語言同理心溝通技巧，與個案建立治療性人際關係，引導個案傾訴死亡將至的無望感並給予心理支持，鼓勵個案與家屬彼此表達愛、感謝，進而表達希望的末期照護方式及交代身後事；運用靈性照護四階段「了解、同理、指引、成長」引導個案與家屬生命回顧、四道人生，完成與妻子見最後一面的心願。經此個案報告，建議末期病人初次住院可照會安寧共照介入，儘早建立治療性人際關係，協助了解情緒困擾、餘生期待，做好臨終準備，完成未了心願；故期望藉此護理經驗分享，做臨床護理人員照顧類似此個案之參考。

This article describes a 83-year-old man terminal colon cancer sought euthanasia because of impending death and hopelessness about life. Patient died a peaceful death with the hospice care provided by a Hospice Shared Care nurse in the medical ward.The nursing period was from January 5, 2019 to February 11, 2019. Through observation, interviews, physical assessment and medical records, collected data and assessment physical, psychological, social and spiritual aspects had health issues ＂chronic pain＂, ＂hopelessness＂, ＂spiritual distress＂. Nursing process, use essential oil massage and acupressure, comfortable lying position to relieve pain. Through companionship, listening and non-verbal empathy communication skills, establish therapeutic relationship, guided the patient to talk about hopelessness arising from the impending death, provided psychological support. Encouraged the patient and the family to express love and gratitude ,to express his wishes for end-of-life care and to express funeral arrangements. The four stages of spiritual care (understanding, empathizing, guiding, growing) to guide the patient through a life review with his family and to complete the four themes of life. He wish to see his wife one last time was finally fulfilled. As a result of this case report, it is recommended that terminally ill patients,When a patient is first hospitalized, Hospice Shared Care could intervene, so that a therapeutic interpersonal relationship can be established with the patient as early as possible to assist the patient and understand the patient's emotional distress and expectations for the rest of his life, so that the patient can be prepared for the end of life and fulfill his unfulfilled wishes. Therefore, it is hoped that through this nursing experience, reference materials can be shared among clinical nursing staff taking care of similar cases.

1. 陳月蓉,王雅芳,郭淑華,楊婉萍(2015)。心慟不捨中放手祝福：一位末期病人之家屬預期性哀傷撫慰。安寧療護，20(1)，79-87。
   連結：
2. 劉芊葳,楊婉萍(2017)。運用同理心溝通技巧提供年輕癌末病人靈性照護。安寧療護雜誌，22(2)，213-227。
   連結：
3. 鄭介炬,陳嘉琪,陳依琳(2018)。照護一位大腸癌併腹膜假性黏液瘤長者無望感之護理經驗。長庚護理，29(4)，633-646。
   連結：
4. 鍾芷涵,陳芝文(2019)。一位初次罹患肝癌末期病人面臨靈性困擾的護理經驗。腫瘤護理雜誌，19(增訂刊2)，43-56。
   連結：
5. (2019).Adult cancer painVersion3.NCCN Clinical Practice Guidelines in Oncology.Journal the of National Comprehensive Cancer Network,17(8),977-1007.
6. Höcker, A,Krüll, A,Koch, U,Mehnert, A(2014).Exploring spiritual needs and their associated factors in an urban sample of early and advanced cancer patients.European Journal of Cancer Care,23(6),786-794.
7. Struck, A F,Muzahir, S,Hall, L T(2015).F-FDG PET/CT and pain in metastatic bone cancer.American Journal of Nuclear Medicine and Molecular Imaging,5(3),287-292.
8. World Health Organization(2018).WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain inadults and adolescents.
9. 台灣安寧緩和醫學學會(2019).安寧緩和醫療末期病人鴉片類藥物臨床使用手冊.新北:合記出版公司.
10. 周慧琍（總校閱）(2018).臨終與生死關懷.台北:華杏出版公司.
11. 陳碩菲(2019)。芳香療法於老人食慾及飲食上的應用。中華自然醫學研究，2(1)，5-17。
12. 陳學凌,羅筱芬(2015)。瀕死病人之護理。內外科護理學，台北:
13. 黃玉琪,吳碧雲,蕭思梅,楊婉萍。疼痛病人之護理。內外科護理學
14. 衛生福利部：安寧療護：癌症防治 。 2018 年 3 月取自 https: //www.hpa.gov.tw/ Pages/ List.aspx?nodeid=210
15. 衛生福利部：107年死因統計結果分析。 2019 年 3 月取自 https: //www.mohw.gov.tw/ cp-16-48057-1.html
16. 鄭如芬,林雅卿,黃百,韋至信,孫嘉玲(2014)。癌症末期病人靈性照護模式。護理雜誌，61(6)，93-97。
17. 簡淑慧,廖美南,李淑慧,林永昌(2014)。從實證觀點談「按摩處置」對於癌痛病人之成效。護理雜誌，61(6)，23-28。