應用羅氏適應理論護理癌末病患善終之經驗

A Nursing Experience for a Terminal Cancer Patient Adjusting to the Peaceful Death Based on Roy’s Adaptation Model

本文報告探討一位高焦慮癌末病患，接受安寧療護而獲得善終之護理經驗，筆者在91年5月27日至91年9月19日護理期間經身體評估、會談、觀察家庭互動、安寧團隊討論之護理活動，依據羅氏適應護理模式評估，發現個案主要護理問題，包括：身體活動功能障礙、疼痛、高危險性感染、身體心像改變、家庭運作過程改變、死亡焦慮。筆者運用護理措施包括：舒適護理、維持身體清潔、解釋告知、同理支持、諮商會談、陪伴等，使病患在生理、心理、靈性等層面獲得調適，降低死亡恐懼，漸能增加對疾病的接受度，協助個案發展出正向適應反應，印證羅氏適應理論適用於癌症末期的照護，期待此照顧經驗分享，能提供臨床實務參考。

This article described the nursing experiences of a 54 years old female patient in severe anxiety with terminal cancer. During May 27 to September 19 in 2002, the patient was assessed by “Roy’s Adaptation Model”, including physical needs, self concept, role function, and interdependence mode. By means of physical examinations, interviews, and observation of family interactions, six nursing diagnoses were identified, including impaired physical mobility, pain, risk of infection, body image disturbance, altered family process, and death anxiety. Nursing interventions were implemented, including supplying comfortable care, maintaining hygiene, informing condition, empathizing, counseling, and accompanying, so that the patient can cope with the adaptation in physical, mental, and spiritual aspects. This patient reduced the fear of death and demonstrated a positive coping response eventually. This case study confirmed that “Roy’s Adaptation Model” is useful in caring terminal cancer patient. This article can serve as a reference in clinical practice.