照顧一位肺癌末期病人接受安寧共同照護之護理經驗

A Hospice Combined Care Experience of Caring for an End-stage Lung Cancer Patient

10.6530/YYN.202407_18(2).0010

劉姵青(Pei-Ching Liu)；梁鈞瑜(Chun-Yu Liang)；施秀鈴(Hsiu-Ling Shih)

肺癌 ； 安寧共同照護 ； 善終 ； lung cancer ； hospice combined care ； good death

源遠護理

18卷2期（2024 / 07 / 01）

77 - 84

繁體中文;英文

本文在探討一位肺癌末期接受安寧共同照護之護理經驗，個案為68歲已婚女士，2020年確診肺癌接受化學治療並定期門診追蹤，因轉移到肝臟持續有肋膜積水、疼痛控制不佳及治療成效不佳，決定採安寧共同照護，對於個案即將面臨死亡而家屬面對個案疾病惡化及瀕死的過程，引發筆者探討動機。照護期間為2020年9月25日至2020年10月6日，運用生、心、社、靈四層面進行整體性評估收集資料，發現個案有慢性疼痛、低效性呼吸型態、預期性哀傷，照護過程中，運用傾聽、關懷、陪伴及鴉片類藥物與按摩、轉移注意力、舒適臥位等非藥物方式，緩解病人疼痛與呼吸困難症狀；並運用安寧照護的四全理念，加上安寧共同照護團隊介入，引導個案及家屬四道人生，使個案獲得善終，家屬獲得善生；並藉此推廣安寧共同照護理念，使更多個案及家屬能獲得更高品質的護理照護。建議臨床護理人員在照護末期病人時，可與安寧共同團隊的社工師、宗教師、心理師以及營養師等不同領域專業人員進行跨領域合作，提供病人更完善及更多元化的照護，提升更優質的護理照護以改善個案生命品質。

This article describes the nursing experience applying hospice combined care to a lung cancer patient at the terminal stage. The case is a 68-year-old married woman who was diagnosed with lung cancer in 2020 and received chemotherapy and regular outpatient follow-up. Due to metastasis to the liver, persistent pleural effusion, poor pain control and treatment. She had faced the condition with rapid decline and fear of death in the terminal stage, and that motivated the author to explore the situation. The caring period was through September 25, 2020 to October 6, 2020. Data were collected by means of physical, psychological, social and spiritual aspects for the assessment of holistic health. The major health problems we found were chronic pain, inefficient breathing patterns, and the anticipatory grief of family members. In the nursing process, use non-drug methods such as listening, caring, companionship, opioid drugs and massage, diversion, comfortable lying position, to relieve the patient's pain and dyspnea symptoms. It is recommended that clinical nurses work with professionals in different fields such as social workers, religious teachers, psychologists, and dietitians from the hospice combined care team to provide better and more diversified care for patients in cross-field cooperation when caring for terminal patients. It is expected that the article could use as a reference in the future for care similar cases.