照顧一位家屬面臨配偶瀕死之哀傷歷程的護理經驗

Nursing Care of a Family in Grieving Process in the Love One ofthe Dying

疾病所帶來的痛苦與面對死亡的恐懼，不但病人受苦，家屬身心上的煎熬也絕不亞於病患本身。本報告旨在分享一位家屬在面臨其配偶瀕臨死亡，歷經哀傷過程的經驗。本個案報告乃應用觀察、會談及記錄與個案、病患之互動過程，寫成十二篇行為過程記錄後，再進行資料歸納分析而成。結果發現其行為表現為（1）出現生理症狀，（2）失落情緒，（3）否認行為，（4）罪惡感，（5）社交退縮行為，綜合其行為表現，可知家屬最主要的問題是預期性哀傷；因此根據哀傷過程理論提供情緒支持，及有計劃告知疾病進展訊息，以促進建設性的哀傷行為，並鼓勵家屬與瀕死伴侶分享彼此的關心及宣洩哀傷的情緒。另外，也協助提醒家屬後事的安排與處理，並建立與其他親友的連繫及提供信仰之訊息，以增加支持系統；最後協助家屬與病人告別，留下美好的回憶，使家屬終能情緒平和地接受伴侶死亡，而將關懷及注意力重新凝聚在女兒的照顧及教育上。本文可供護理人員日後評估瀕死病人家屬預期性哀傷的依據及擬定護理計劃之參考。Patients suffer pain from disease and fear to face death, and their families also have these suffering experiences. This case study described the nursing care of a female adult who was a caregiver of her dying husband. The researcher was a participant engaged both in nursing care and data collection. Content analysis was applied to 12 process recordings to identify the caregiver's experiences during her husband's death. The caregiver's behaviors were categorized as (1) physical signs and symptoms, (2) loss, (3) denial behaviors, (4) guilty feelings, (5) social withdrawal. Anticipatory grieving was her major health problem as stated. Based on grieving process theory, the nurse provided the client emotional support, disease progress of her husband, and encouraged expression of feelings in ways comfortable to the husband. Otherwise, the nurse assisted the client in arranging the ceremony to the deceased, and building up relationships with other families. Finally, the researcher assisted the client in saying goodbye to her husband, keeping treasuring memories of happiness, peacefully accepting the loss, and paying attention her daughter's care. The findings of this study provide references for nurses taking care of patients with feelings of grief.