一位白血病患者移植後復發面對死亡焦慮之護理經驗

The Nursing Experience of a Patient with Relapse of Acute Lymphoblastic Leukemia Who was Facing Her Dying Anxiety after Stem Cell Transplantation

本文描述一位年輕急性淋巴性白血病女性患者，接受異體造血幹細胞移植後，發生移植物抗宿主疾病，因肺部纖維化嚴重，需仰賴氧氣維生，於門診常規追蹤檢查時發現癌症復發，住院後病情急劇惡化，個案及其母親無法面對死亡焦慮之護理經驗。筆者於2009年2月10日至4月5日運用Gordon十一項健康功能評估個案發現其健康問題有活動無耐力、死亡焦慮及抉擇衝突。筆者透過耐心陪伴、傾聽並接受個案情緒反應，與其共同擬定運動計劃，並執行持續性漸進式運動，使其改善活動耐力；此外更深入案母世界，給予同理與支持，體恤身為人母之立場，最後與其他醫療團隊成員一同合作，使患者面臨抉擇衝突、死亡焦慮之時，末期臨終階段能向案母表達自己的想法，掌握生命的自主權，最後能依循自主之意願安詳往生，期盼本篇個案報告之護理經驗能做為未來照護類似個案之參考。

The purpose of this article was to describe the nursing experience of a young woman with Acute Lymphoblastic Leukemia (ALL). She suffered a Graft-Versus-Host–Disease (GVHD) after she underwent Hematopoietic Stem Cell Transplantation (HSCT). Due to the serious pulmonary fibrosis, she need oxygen therapy. Unfortunately, she was diagnosed with a relapse of ALL after a routine follow-up. After hospitalized her condition deteriorated rapidly; thus, she and her mother could not accept reality and had difficulty of coping with the dying anxiety. The first author was her primary nurse who took care of her between February 10, and April 5, 2009. The Gordon’s functional health assessment was used to assess her health problems such as activity intolerance, death anxiety, and decision conflict. The author used patience, listening, and accepting skills to deal with her emotional response. In order to improve her activity intolerance, the author designed the exercise program. In addition, we took care of her mother by using empathy and support to understand her mother’s inner feelings about her disease. Finally, we cooperated with the other medical teams, which also provided suggestions for how the patient faced decision conflict and dying anxiety.