照顧一位大腸癌末期疾病進展快速病人之善終護理經驗

Nursing Experience of Caring for a Patient with Rapid Progression of Colon Cancer

10.6740/NTUHJN.202007_16(2).0005

柯美如(Mei-Ju Ke)；陳美君(Mei-Chun Chen)；洪敏瑛(Ming-Ying Hong)

大腸癌 ； 安寧療護 ； 善終 ； 臨終 ； colorectal cancer ； hospice care ； good death ； end-of-life care

臺大護理雜誌

16卷2期（2020 / 07 / 01）

41 - 52

繁體中文

本文主要描述一位大腸癌末期的中年單身男性，入院進行首次化學治療，但因疾病惡化迅速，接受治療後如何面臨死亡衝擊與威脅的護理經驗。於2017年7月8日至8月24日照護期間，藉由直接護理、觀察、會談及查閱病歷收集資料，依生、心、靈、家庭及社會層面進行整體性的評估與分析，確立個案有「疼痛」、「低效性呼吸型態」及「死亡焦慮」三項主要健康問題，依其問題擬定護理計畫及目標，提供持續性照護及個別性護理措施。給予正確的止痛藥使用認知，教導家屬協助按摩、舒適擺位等非藥物之輔助方法改善其疼痛問題。針對低效性呼吸型態，評估個案使用需求，教導個案使用正確的呼吸運動及臥姿以促進呼吸和肺部擴張，減少呼吸困難。個案因末期惡化快速，治療成效不佳，需要面臨死亡問題，在複雜生理、心理變化與照顧需求，引發想分享如何運用全人照護理念引導個案及家屬表達彼此的情感達到善終，善用跨領域團隊資源與安寧療護技巧，期望提供護理人員臨床實務之參考，提升病人照護品質。

This article described a unmarried male with terminal colorectal cancer facing death due to rapid progression of the disease in about one month. Data were collected through direct care, observation, interviews, and medical record review from July 8 to August 24, 2017. We developed the nursing plans and goals to provide continuous and individual care based on a comprehensive assessment of physical, psychological, spiritual, family, and social aspects. The identified health issues were pain, inefficient breathing pattern, and anxiety about death. He and his family members were provided with an instruction on the correct use of painkillers and non-pharmacological methods, such as massage and comfortable placement. Oxygen was provided for the inefficient breathing pattern, but we also taught the patient about correct breathing and lying in a comfortable posture to enhance breathing and lung expansion to reduce breathing difficulties. The concepts and skills of hospice care were applied to help the patient face the anxiety of death and the patient was guided to express love, repentance, and gratitude toard his family. We hope that sharing this end of-life care experience will improve the quality of end of life nursing care and can be used as a reference for clinical nursing staff.

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