運用Swanson關懷理論於一位癌症末期經歷整體痛病人之全人照護經驗

Nursing Experience of Holistic Care Applying Swanson's Caring Theory in a Patient with Terminal Cancer with Total Pain

10.6740/NTUHJN.202401_20(1).0006

朱峻銘(Chun-Ming Chu)；羅美芳(Meei-Fang Lou)

全人照護 ； 跨團隊照護 ； Swanson關懷理論 ； 癌症末期病人 ； 整體痛 ； Holistic care ； interdisciplinary team ； Swanson's caring theory ； terminal cancer patient ； total pain

臺大護理雜誌

20卷1期（2024 / 01 / 01）

52 - 63

繁體中文;英文

本文描述一名62歲肺癌末期女性經歷整體痛之全人照護經驗；於2022年3月03日至3月24日護理期間，藉由觀察、會談、傾聽及查閱病歷等方式收集資料，初步與醫療團隊討論後，發現個案有「整體痛」情形，爾後運用整體性評估，確立個案有「舒適障礙」、「焦慮」之健康問題；本文以Swanson關懷理論為照護指引，運用其五大關懷核心於照護中，充分展現護理的獨特性與重要性，而現今醫療場域多強調團隊照護，以達全人照護的目標，在這之中「護理」的角色更為突出，就像團隊中的「橋樑」般重要，如本文個案在症狀控制得宜，準備出院之際，對於返家出現哭泣等情緒反應，護理師透過大量傾聽陪伴，瞭解個案對於出院焦慮的原因，與團隊成員討論且安排各項準備措施，最終使個案得以安心返家，達成圓滿的結果；建議照護此類個案時，以「跨團隊照護」為策略，可以達到良好的照顧成效；另外居家安寧團隊訪視時，應同時給予主要照顧者負荷量評估，必要時給予適當介入措施或轉介。

This study describes the holistic care experience of a 62-year-old female with terminal lung cancer. During the nursing period from March 3 to 24, 2022, the patient was identified as experiencing "total pain" through the application of various data collection methods, including medical record collection, physical evaluation, interview, and discussions with the medical team. Furthermore, the patient had health issues of "impaired comfort" and "anxiety." In this study, Swanson’s five core caring concepts was used as a valuable guide to demonstrate the unique and important role of nursing in patient care. Currently, the medical field emphasizes the importance of an "interdisciplinary team" approach to achieve holistic care, in which the role of nursing is particularly prominent as they serve as a "bridge" in the team. As the patient in this study was ready for discharge from the hospital with well-controlled symptoms, the nursing staff listened carefully and provided support to understand why the patient was anxious about the discharge process. The nursing staff immediately discussed with the team members, and arranged various preparatory measures, which eventually helped the patient return home with peace of mind and achieved a satisfactory outcome. Thus, an "interdisciplinary team" approach is recommended for achieving good nursing outcomes when caring for such patients. In addition, hospice home care teams should assess the primary caregiver for interventions or referral evaluations.