照顧罹患末期骨巨大細胞瘤青年瀕臨死亡之護理經驗

The Experience of Caring for a Young Adult with Giant Cell Tumor of Bone in the Dying Process of the Terminal Cancer Stage

10.6740/NTUHJN.201801_14(1).0011

李心瑋(Hsin-Wei Lee)；張祐菱(Yu-Lin Chang)；鄭如芬(Ju-Fen Cheng)

骨巨大細胞瘤 ； 死亡焦慮 ； 哀傷 ； 安寧療護 ； giant cell tumor of bone ； death anxiety ； grief ； hospice care

臺大護理雜誌

14卷1期（2018 / 01 / 01）

104 - 114

繁體中文

本文描述罹患末期骨巨大細胞瘤合併肺臟、腹內肌肉及骨轉移青年面臨瀕臨死亡之護理經驗。護理期間為2015年10月10日至10月26日，運用生理、心理、社會及靈性評估模式進行整體評估，歸納影響個案身心舒適之「慢性疼痛」、「死亡焦慮」以及家屬所面臨之「哀傷」反應為主要健康問題。護理過程除了使用藥物，藉由翻身枕、音樂療法、按摩及調整舒適臥位，減輕個案癌症轉移所導致的疼痛感；面對個案淡漠、焦慮及害怕死亡的情緒，積極傾聽陪伴，給予關懷並提供心裡支持；同時引導家屬抒發悲傷情緒，透過教會義工、安寧照護團隊與腫瘤心理師的支持，共同協助家屬及個案面對死亡之心理準備。期盼此臨床照護經驗分享，能提供護理師日後照護年輕面臨死亡個案之參考，以提升臨終照護品質。

This article described the hospice care experience of a young adult facing death due to giant cell tumor of bone with lungs, intra-abdominal muscle, and bone metastases. The period of nursing care was from 10 to 26 October 2015. After conducting the physical, psychological, social, and spiritual holistic assessments, we identified the patient’s problems, which included chronic pain, death anxiety, and the grief reactions among family members. During the nursing care process, in addition to providing medication for pain control, the nursing interventions also included turnaround techniques on the bed, music therapy, massage, and arrangement of the comfortable positions to alleviate pain due to terminal cancer. For the patient's apathy, anxiety, and fear of death, nurses provided active listening and support. With the involvements of church volunteers, hospice team members, and the psychologist, we helped family members and the patient to express their grief and prepare for the dying process. These nursing care experiences could be applied in caring the young adult patient facing death due to terminal cancer.