一位門診初診斷肝癌末期病人無望感之護理經驗

Nursing Experience of Caring for an Outpatient with Newly Diagnosed of Terminal stage hepatocellular carcinoma

黃淳瑄(Chuen-Hsuan Huang)

肝癌末期 ； 無望感 ； 心靈困擾 ； terminal stage hepatocellular carcinoma ； hopelessness ； spiritual distressy

若瑟醫護雜誌

18卷1期（2024 / 06 / 01）

129 - 141

繁體中文;英文

本文旨在協助一位初診斷肝癌末期患者調適身心問題之經驗。護理期間為2020年7月29日至2020年9月15日，透過身體評估、會談、觀察及直接照護等方式進行生理、心理、社會及靈性方面評估，確立個案有「營養少於身體需求」、「無望感」及「心靈困擾」等健康問題。照護期間與個案建立良好的信賴關係後，在營養需求方面，先了解個案對飲食的需求與偏好，再與其及家屬、營養師共同討論擬定飲食計畫，以增加飲食意願與熱量攝取；在無望感方面，除了運用同理心，鼓勵個案表達出內心感受，並引導其回憶過往養兒育女之成就，肯定自我價值外，亦營造個案可做到的情境，當其達成目標時給予正向回饋，以改善其無望感；在心靈困擾方面，透過生命回顧法，鼓勵其參與有意義活動，肯定自我存在意義的同時，亦協助其重新體悟生命意義與價值，讓其心靈獲得安適，進而調適疾病帶來的身心靈衝擊，坦然面對剩餘人生與表達出餘生對醫療的期待，讓家屬依照其心願協助其走完人生最後階段，畫下完美句點。希冀此照護過程經驗與同儕分享，提供護理人員日後照護此類疾病個案參考。

The experience of assisting a patient newly diagnosed with terminal stage hepatocellular carcinoma in adapting to the patient's physical and mental problems. During July 29, 2020 to September 15, 2020, we evaluated the case's physical, mental, social and spiritual statuses to affirm that the case was suffered from "imbalanced nutrition: less than body requirements", "hopelessness" and "spiritual distress" by physical examination, conducting meeting, observation and direct care. During the nursing period, a trust relationship was first established with the patient. Regarding nutritional needs, the patient's dietary needs and preferences were first determined before a dietary plan was jointly formulated and discussed with the patient, their family, and dietitian to improve his willingness to eat and caloric intake. Regarding hopelessness, besides employing empathy, encouraging the patient to express their inner thoughts, guiding them to reminisce about their parenting achievements, and affirmation of their self-worth, scenarios that the patient could complete were also created. The patient was given positive feedback when they completed the goals to decrease hopelessness. With regard to spiritual distress, the life review method was used to help the patient search for the meaning of existence and newly appreciate the meaning and value of life. The patient was also guided and encouraged to participate in meaningful activities and take photographs as mementos for family members, thereby facing and adapting to the physical, mental, and spiritual impact of the disease, facing their remaining life calmly and expressing medical expectations for their remaining life. This allowed family members to send them off according to the patient's wishes and provide a perfect ending. We hope that sharing this nursing experience with our fellow peers can provide a reference for future care of such cases by nurses.