運用安寧療護於肺癌末期病人的護理經驗

The Nursing Experience of a Terminal Patient with Lung Cancer: An application of Hospice Care

本文是秉持安寧療護全人、全家、全程、全隊的四全照護理念，探討照顧一位肺癌病人身、心、靈至善終的護理經驗分享。於94年9月13日至10月10日的照護期間，運用Gordon十一項功能性健康評估，確立病人有：疼痛、皮膚完整性受損、自主性換氣失能、預期性哀傷及焦慮等健康問題。以個別性護理措施，運用輔助療法，發揮護理獨特功能，有效減緩疼痛及呼吸窘迫症狀，協助按摩及翻身擺位，避免皮膚再損傷，增進舒適更提升生活品質；另透過會談、觀察及傾聽方式，發現案家整體性的痛苦，面臨死亡迫近的哀傷與焦應，因此積極關懷、鼓勵、接納病人與家屬表達疑惑和情感，透過坦承的溝通、真實的擁抱，化悲傷為永恆的愛，以繪畫、錄音、照相等方式，留給子女紀念，轉介宗教師　病人及案妻開釋，使靈性有寄託而不再害怕，最後完成病人後事交代與安排，達成生死兩相安的使命。期望藉此珍貴的護理經驗與讀者分享，並為日後臨床照護之參考。This article describes the experience of a hospice team in nursing a terminal lung cancer patient and enabling a good death. The hospice team utilized the four-whole theory of palliative care: Whole man, whole family, whole process, and whole team care in caring for this patient. During hospitalization from Sep. 13th to Oct. 10th 2006, the authors utilized Gordon's 11 functional health styles to evaluate pain, impaired skin integrity, inability to sustain spontaneous ventilation, anticipatory grief, and anxiety. During this period, the authors first provided this patient with individualized nursing care, and professional knowledge and skill to help relieve symptoms such as pain, enable better breathing, and also used massage and change of position to protect the skin. The authors also tried to provide the patient with a better quality of life. Moreover, the suffering, grief and anxiety of death of the family were approached carefully by interview, during which the authors examined and listened to the family’s concerns. The authors exercised active attention and encouraged family members to express their true feelings and have more open-hearted conversations emotionally close to each other. Family members were encouraged to face the true situation bravely and to move through grief to lasting love. In addition, family members recorded themselves in graph, audio, and photographs for their children. As for coping with terminal illness, the patient no longer feared death, and got past the process of grief and bereavement. We also introduced priest to him and also encouraged his prayers. Finally, he made his last confession, and we helped him get home care so that he could die at home. With strong support and preparation, his family completed the funeral affairs and coped with their grief quite well and in a state of grace. We hope to share our precious experience for reference in future clinical nursing care.