一位肝癌末期患者欲捐贈眼角膜之照護經驗

The Nursing Experience of a Hepatocellular Carcinoma Patient in Terminal Stage Who Wanted to Donate Corneas

本文旨在描述一位肝癌末期患者欲捐贈眼角膜的護理經驗。照護期間為2011年6月24日至7月2日，筆者經由觀察、會談、身體評估及查閱病歷等方式收集資料，運用Gordon十一項功能性健康型態做為評估工具，確立個案主要健康問題有：(1)抉擇衝突／不知該不該捐贈眼角膜所產生；(2)案母則有預期性哀傷／個案即將死亡有關。護理期間除提供個別化的照護措施，亦藉由傾聽、澄清、關懷與陪伴，宣洩、撫慰個案及案母悲傷情緒，並與關懷師、安寧照護小組、器捐小組等各專業醫療團隊合作，協助家屬面對死亡外，也化解個案與案母間對器官捐贈的衝突，以順利完成個案器官捐贈的心願，使個案身心層面均獲得滿足且無憾。期待該護理經驗能提供臨床護理同仁照護之參考。

The article described the nursing experience of a terminal liver cancer patient who wanted to donate his corneas. The period of nursing care was from June 24 to July 2 in 2011. The authors used the Gordon's Eleven Functional Health Patterns to collect objective and subjective information by the methods of observation, interview, physical examination, and medical record review. We found that major nursing problems of this patient were: (1) the patient had conflicting decision of whether to donate his corneas or not; (2) the mother of the patient had anticipatory grief . During the period of nursing care, besides providing individualized cares , we also collaborated with other professional medical teams, including the palliative care team and donation groups, to get things off their chests by listening, clarifying, caring, and accompanying. Moreover, we not only helped family members to face the patient's death but also reconciled the conflicting decision of organ donation between the patient and his mother. The team successfully achieved his willingness of organ donation and satisfied his physiological and psychological needsnear the end of his life. We hope that this nursing experience could be a reference for nursing staff dealing with similar situation in the future.