照顧一位恐懼化療副作用而中止治療個案之護理經驗

The Nursing Experience of Caring a Patient who Discontinued the Chemotherapy Due to Fear for Side Effects

本篇報告主要描述一位週邊型T細胞淋巴瘤之個案，因經歷過化療嚴重副作用，以致恐懼再次面對化療之身、心不適症狀，最後選擇逃避、中斷治療，及至癌症轉移才又無奈的再次入院接受化療，然而，個案住院後面對化療的恐懼感仍未減低，因此引起筆者想要進一步探究的動機。筆者於2007年5月21日至6月20日護理個案，以Gordon十一項健康功能評估工具評估個案，經由與個案互動、觀察、深入會談收集資料，發現個案的身、心問題為：噁心嘔吐、口腔黏膜改變、身體心像紊亂及恐懼。重要的是，筆者發現個案面對這些化療副作用時表現出無助及不知所措，故逃避治療的心態再次燃起，因顧慮家中幼子，日常生活需要依賴母親的照顧，個案因情境所使，必須克服恐懼心理，繼續來院接受治療。筆者透過適時的提供具個別性的化療副作用之相關護理處置，提供因應化療副作用之策略，藉由減輕個案化療期間之生理不適及心理壓力，扭轉個案接受化療副作用的不好經驗，使得個案有勇氣且願意繼續接受化學治療。

This article describes the caring experience of a patient with peripheral T-cell lymphoma who underwent severe chemotherapy side effects and discontinued the treatment due to physiological, psychological discomfort. For this reason, she readmitted to receive cancer chemotherapy for lymphoma recurrence; however, her fear for chemotherapy persisted. To alleviate her stress, we provided nursing care using proper nursing-patient interaction, observation, and discussion from May 21, 2007 to June 20, 2007. The Gordon’s functional health assessment guide was used to identify physiological and psychological problems. The health problems included nausea/ vomiting, oral mucous membrane, altered body image disturbance, and fear. Most importantly, we discovered that the patient felt helpless and alone. Moreover, the patient was concerned about taking care of her son and in need for help from her mother. In order to help her overcome the fear and resume treatment, we provided her with individualized nursing care to alleviate physical discomfort and psychological stress from chemotherapy.