肺癌生命末期病人的護理經驗

Nursing Experience for an End-of-Life Patient with Lung Cancer

肺癌為高致死率的癌症之一，對個人、家庭而言都會造成很大的影響與傷害，即使是在急性照護單位，也能在病人生命最後階段，提供舒適的生理及心靈護理，使癌症末期病人在沒有痛苦，且有尊嚴的情境之下走完生命旅程。本文探討一位86歲男性病人，於初次檢查即發現罹患肺癌末期而住進加護病房，並於病情脫離危險期後轉入呼吸照護中心，於2009年8月26日至10月7日於呼吸照護中心護理期間，運用Gordon十一項功能性健康型態評估，藉由會談、觀察、傾聽方法收集資料作整體性評估，發現個案有疼痛、呼吸道清除功能失效、及家屬的預期性哀傷等三項護理問題，護理過程中，藉評估瞭解個案生理、心理、各層面的需要，協助維持其身體舒適之基本需要，讓個案因疾病所造成身體不適獲得疼痛緩解。另提供家人支持系統，協助以正向態度來面對悲傷過程，發揮同理心給予支持，鼓勵其表達內心感受並傾聽，以減輕家屬面對個案死亡的哀傷與焦慮，並將此護理經驗提供與同仁在未來照護此個案有一經驗之分享。

Lung cancer is one of the cancers with a high mortality rate. It causes huge impacts on patients and their families. However, cancer patients at the end-of-life stage can obtain comfort care in physical and psychological aspects without pain and with respect, respectively. This article describes a nursing care study of a 86-year-old male patient diagnosed with stage IV lung cancer on his first medical appointment. The patient was admitted to the intensive care unit and then transferred to the respiratory care center when his condition stabilized. The nursing care was from Aug. 26 to Oct. 7, 2009, the duration of the patient's at the respiratory care center. The author collected data through interview, observation, and listening with empathy. After using Gordon's functional health assessment, the three identified main problems were pain, maintenance of airway cleanliness, and anticipatory brief. The hospice team assessed the patient's comfort needs in physical and psychological aspects and maintained the patient's basic physical comfort with pain relief. With empathy and active listening, the supportive team assisted the family members in positively facing the patient's death, further reducing their level of anxiety. This article shared a personal experience with other nurses caring for end-of-life patients.