肝癌臨終病患身心靈之照護經驗

Physical, Psychological, and Spiritual Care Experiences of a Terminal Patient with Liver Cancer

本報告乃探討一位肝癌臨終病患於接受安寧療護後獲得身、心、靈照護之經驗。筆者透過身體評估、會談、傾聽、觀察家庭互動及運用安寧團隊照護等方式，以羅氏適應模式為架構，進行個案身、心、靈等層面的評估，確立個案有慢性疼痛、情境性低自尊、心靈困擾等健康問題。護理措施乃透過傳統及非傳統止痛藥物的方式減輕個案的疼痛指數；同時協助其以有限的能量及功能來完成日常生活活動，藉此增進個案的自尊，並採循序漸進的方式運用會談、輔導及透過生命回顧尋找其生病痛苦之意義，使個案在住院期間感受到被妻子和兒女寬恕，並經歷饒恕自己、被愛和愛人的過程，使其有勇氣面對、接受、並準備自己的死亡。藉由本文探討肝癌臨終病患身、心、靈護理過程，建議在個案往生後，可藉由社工人員的電話追蹤，引領家屬緩解其哀傷反應，或經由居家安寧照護方式進行遺族關懷，及轉介至相關的支持團體，以達全人、全家、全程、全隊的最高照護品質。

This report described the nursing experience of a terminal liver cancer patient who has obtained physical, psychological, and spiritual care experiences after hospice care. The author assessed physical, psychological, and spiritual aspects of the case by the ways of physical assessment, conversation, listening, observing family dynamics, hospice team care, and Roy Adaptation Model. Chronic pain, situational low self-esteem, and spiritual distress health problems were identified for the case. Nursing interventions for the case is to release his pain indicators through non-traditional pain-killer medicines and assist him to complete daily life activities by limited energy and function. Through the intervention process, the case’s self-esteem has been promoted so that he could search for the meaning of illness and pain by the way of conversation, education, counseling, and life-reviewing gradually. Additionally, the case has experienced being forgiven by his wife and children, being able to forgive himself, appreciated the process of being loved and loved, and had the courage to face, accept, and prepare his own death. Through exploring the physical, psychological, and spiritual care experiences of the terminal liver cancer patient, the author suggested social workers can follow up the case’s family and release their grief responses after the case’s death by telephone calling, hospice home care of family members, and transferred into the supporting groups that could achieve the highest quality of care in the whole person, whole family, whole process, and whole team.