一位胰臟癌末期病人臨終之護理經驗

The Nursing Experience of Handling End-of-Life about a Patient with Pancreatic Cancer

黃雅婷(Ya-Ting Huang)

胰臟癌 ； 臨終 ； 護理經驗 ； Pancreatic cancer ； End-of-life concerns ； Nursing experience

醫學與健康期刊

6卷2期（2017 / 09 / 01）

113 - 123

繁體中文

本文為陪伴一位罹患胰臟癌末期病人面對生理不適、無力感及靈性困擾之臨終護理經驗。筆者於護理期間自2015年02月07日至2015年03月01日，運用觀察及身體評估，進行生理、心理、社會及靈性層面之整體性評估，確立個案主要問題有：疼痛、無力感及靈性困擾。在照護過程中結合醫療團隊評估與用藥，合併芳香及音樂療法、舒適臥位，以達到緩解個案的疼痛；運用關懷、傾聽、支持、陪伴、同理技巧，協助個案表達自己對生命的接受度，改善其無力感；偕同安寧護理師、社工及宗教師的力量，撫慰個案之靈性困擾，找到心靈上的依歸。建議未來應持續推廣安寧照護之在職教育，輔導護理人員照護癌末病人的知識與技能，提升臨終病人之生活品質，亦期盼此報告之分享，提供護理人員日後在照護臨終病人的參考，讓病人得到善終的目的。

This work focuses on the nursing experience encountered while dealing with a hospice patient suffering from pancreatic cancer. From February 7, 2015 to March 1, 2015, patient data were collected by observation and physical assessment, indicating the patient's major concerns to be pain, powerlessness, and spiritual conflict. Effective management of these concerns involved coordination between the nursing and medical team. In addition to prescribed medications, the patient was also treated music and aromatherapy and kept in a comfortable lying position. During this time, the patient received active care, listening, support, accompaniment skills, and empathy. The collaborative actions of the hospice nurses, social workers and spiritual guidance counselors helped improve the patient's sense of powerlessness, accept disease status, and resolve the patient's spiritual conflicts. This case underscores the need for continued promotion of education on how to manage hospice patients. This would further enhance the nurse's knowledge and skills towards more effective care of patients who are in the terminal stage of life. It is hoped that this brief yet meaningful nursing experience can help highlight some the special nursing problem and encourage further endeavors in the field of hospice care.

1. 衛生福利部國民健康署：中華民國101年癌症登記報告，2012。Health Promotion Administration Ministry of Health and Welfare Taiwan: Cancer Registry Annual Report, 2012.
2. Carina, S,Contributing, W(2015).Complementary care interventions.Association of Perioperative Registered Nurses,101,7-9.
3. Chen, H,Liu, TY,Kuai, L,Zhu, J,Wu, CJ,Liu, LM(2013).Electroacupuncture treatment for pancreatic cancer pain: a randomized controlled trial.Pancreatology,13,594-7.
4. Kanji, ZS,Gallinger, S(2013).Diagnosis and management of pancreatic cancer.CMAJ,185,1219-26.
5. Messina, G,Anania, S,Bonomo, C(2011).The importance of spirituality in supportive care.Int J Yoga,4,33-8.
6. Pittroff, GE(2013).The humbled expert: An exploration of spiritual care expertise.Journal of Christian Nursing,30,164-9.
7. Torgerson, S,Wiebe, LA(2013).Supportive care of the patient with advanced pancreatic cancer.Oncology,27,183-90.
8. 江慧珣、莊于君、周桂如(2001)。癌症疼痛之處置。腫瘤護理雜誌，1，64-73。
9. 吳莉芬、賴慧文、潘雪幸(2011)。一位肺癌末期病患接受安寧療護之經驗。腫瘤護理雜誌，11，37-46。
10. 李昱平(2010)。生命教育中的幽谷伴行─談臨終關懷與安寧療護。諮商與輔導，290，26-30。
11. 林綺雲、張莞珍、邱鈺雯(2011)。臨終與生死關懷。臺北市=Taipei City:華都文化=Huadu Culture。
12. 洪惠容、梁明泰、洪昭安、黃淑萍(2013)。以安寧療護護理理念照護一位肝癌末期病人之經驗。長庚護理，24，424-34。
13. 許雅媚、馮文心、陳淑賢、許秋敏(2011)。一位腎細胞癌合併骨轉移患者之居家照護經驗。長庚護理，22，529-36。
14. 陳旺全(2011)。胰臟癌之治療。北市中醫會刊，17，18-26。
15. 陳雅琪、楊立華、張理君、廖珍娟(2011)。臨終癌症病患家庭之關懷。腫瘤護理雜誌，11，1-12。
16. 陳慧琪、賴思妤(2010)。肺癌生命末期病患的護理經驗。領導護理，11，33-42。
17. 曾雅玲、涂秀妮(2009)。一位口腔癌末期合併惡性腫瘤傷口病患之護理經驗。腫瘤護理雜誌，9，61-71。
18. 馮永霖(2013)。臨終關懷與臨終病患需求之探討。諮商與輔導，332，16-20。
19. 黃麗靜、陳紀伃(2011)。照顧一位腦部腫瘤病患之護理經驗。志為護理，10，105-16。
20. 簡慧琪(2010)。運用靈性照護於一位肝癌末期病人之護理經驗。護理雜誌，57，47-52。