應用同在概念於一位年輕乳癌末期女性的護理經驗

The Nursing Experience of Being With a Dying Young Woman with Terminal Stage of Breast Cancer

10.6530/YYN/2016.4.2

林靜伶(Ching-Ling Lin)；陳玉如(Yu-Ju Chen)

乳癌 ； 同在 ； 抉擇衝突 ； 死亡焦慮 ； breast cancer ； being with ； decisional conflict ； death anxiety

源遠護理

10卷2期（2016 / 06 / 01）

54 - 62

繁體中文

本文描述照護一位選擇使用自然療法之年輕女性乳癌個案，於癌症末期面對死亡焦慮之經驗。筆者於2014/11/06至2014/12/01照顧期間利用觀察、訪談進行生理、心理、社會和靈性方面的評估，發現個案有因腫瘤出血引發體液容積缺失、面對醫療處置的抉擇衝突和癌症末期引發死亡焦慮的健康問題。照護過程中以同在（being with）的照護概念，運用專業知識提供個別性的護理，以降低其腫瘤傷口的出血，緩解體液容積缺失的問題；同理個案選擇自然療法的決定，以減少其經歷癌症惡化至末期的後悔及衝突感受；提供個案與家屬親友心理支持，鼓勵打開彼此心房，共同談論死亡議題和感受，讓彼此更坦然面對死亡的臨近，且及早因應與準備，為生死兩相安的目標而努力。冀望此照顧經驗的分享，能作為臨床醫護人員於照護類似個案的參考和運用。

This article describes a nursing care experience of a young female patient diagnosed with terminal breast cancer, who is receiving alternative medicine treatment and experiencing death anxieties. Observations and interviews of the patient’s physiological, psychological, sociological and spiritual wellbeing, and the nursing diagnoses of the problems were fluid volume deficit due to tumor bleeding, conflicts from her decision on alternative medicine treatment, and terminal stage death anxiety. The author integrated the concept of being with in caring for this patient. The interventions included provision of professional skills and knowledge to ameliorate tumor bleeding and fluid volume deficit, which showed empathy on her decision for alternative medicine, her regrets and emotional conflicts during cancer progression, which also facilitated death conversations in an open-minded atmosphere between the patient and her family and friends to accept the peaceful death. This caring experience may offer reference for health care providers in caring for end stage cancer patients.

1. Hsu, S. C.,Wang, H. H.,Chu, S. Y.,Yen, H. F.(2010).Effectiveness of informational and emo-tional consultation on the psychological impact on women with breast cancer who underwent modified radical mastectomy.Journal of Nurs-ing Research,18(3),215-226.
   連結：
2. Baek, S. K.,Kim, S. Y.,Heo, D. S.,Yun, Y. H.,Lee, M. K.(2012).Effect of advanced cancer patients’ awareness of disease status on treat-ment decisional conflicts and satisfaction during palliative chemotherapy: A Korean prospective cohort study.Supportive Care in Cancer,20(6),1309-1316.
3. Banning, M.,Hafeez, H.(2009).Perceptions of breast health practices in Pakistani Muslim women.Asian Pacific Journal of Cancer Pre-vention,10(5),841-847.
4. Buglass, E.(2010).Grief and bereavement theories.Nursing Standard,24(41),44-47.
5. Ching, S. S.,Martinson, I. M.,Wong, T. K.(2012).Meaning making: psychological adjustment to breast cancer by Chinese women.Quali-tative Health Research,22(2),250-262.
6. Del Gaudio, F.,Zaider, T. I.,Brier, M.,Kissane, D. W.(2012).Challenges in providing fam-ily-centered support to families in palliative care.Palliative Medicine,26(8),1025-1033.
7. Emilia, M.,Luca, S.,Francesca, B.,Luca, B.,Paolo, S.,Giuseppe, F.,Mauro, L.(2011).Topical hemostatic agents in surgical practice.Transfu-sion and Apheresis Science,45(3),305-311.
8. Graham, C. A.,Parke, T. R.(2005).Critical care in the emergency department: shock and circulato-ry support.Emergency Medicine Journal,2(1),17-21.
9. Hicks, D.,Cummings, T., Jr.,Epstein, S. A.(2010).An approach to the patient with anxiety.Medi-cal Clinics of North America,94(6),1127-1139.
10. Kaiser, K.(2008).The meaning of the survivor identity for women with breast cancer.Social Science & Medicine,67(1),79-87.
11. Knobf, M. T.(2007).Psychosocial responses in breast cancer survivors.Seminars in Oncology Nursing,23(1),71-83.
12. Kübler-Ross, E.(1969).On Death and Dying.New York:The Macmillan Company.
13. Lehto, R. H.,Stein, K. F.(2009).Death anxiety: An analysis of an evolving concept.Research and Theory for Nursing Practice,23(1),23-41.
14. Lo, S. F.,Hu, W. Y.,Hayter, M.,Chang, S. C.,Hsu, M. Y.,Wu, L. Y.(2008).Experiences of living with a malignant fungating wound: A qualitative study.Journal of Clinical Nursing,17(20),2699-2708.
15. Nazareth, I.,Jones, L.,Irving, A.,Aslett, H.,Ramsay, A.,Richardson, A.,King, M.(2008).Per-ceived concepts of continuity of care in people with colorectal and breast cancer--a qualitative case study analysis.European Journal of Cancer Care,17(6),569-577.
16. Pesut, B.,Bottorff, J. L.,Robinson, C. A.(2011).Be known, be available, be mutual: a qualitative ethical analysis of social values in rural palli-ative care.BMC Medical Ethics,12(19),1-11.
17. Sener, S. F.,Winchester, D. J.,Winchester, D. P.,Bar-rera, E.,Bilimoria, M.,Brinkmann, E.,Du, H.(2006).Survival rates for breast cancers detect-ed in a community service screening mammo-gram program.The American Journal of Sur-gery,191(3),406-409.
18. Swanson, K. M.(1991).Empirical development of a middle range theory of caring.Nursing Re-search,40(3),161-166.
19. Tornoe, K. A.,Danbolt, L. J.,Kvigne, K.,Sorlie, V.(2014).The power of consoling presence - hos-pice nurses’ lived experience with spiritual and existential care for the dying.BMC Nursing,13(25),1-8.
20. 王秀紅,黃志中(2010)。婦女的健康促進與疾病預防。醫療品質雜誌，4(3)，28-30。
21. 台灣癌症登記中心（2013）．癌症五年相對存活率．http://tcr.ntu.edu.tw/uploadimages/Survival _99_10.pdf
22. 李作英,周桂如,李惠玲,葉美玲(2012)。初診斷乳癌婦女其壓力感受。腫瘤護理雜誌，12(2)，25-36。
23. 林惠文,顏啟華,應宗和(2006)。乳癌的篩檢與診斷。基層醫學，21(12)，352-358。
24. 黃齡慧,張美幸,張碧華(2013)。一位末期肺癌病人接受安寧共同照護之護理經驗。榮總護理，30(3)，289-296。
25. 楊婉伶,李存白,張靜安(2007)。運用安寧療護於肺癌末期個案善終的護理。新台北護理期刊，9(2)，81-91。
26. 衛生福利部統計處（2016）．103年度衛生統計動向．取自http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&fod_list_no=5988

1. 曾婉婷,陳姲諪,張嫚娜(2020).照顧一位年輕乳癌病人合併腰椎轉移之護理經驗.彰化護理,27(3),98-110.