照護一位肝癌末期病患面對死亡恐懼之護理經驗

Nursing Care of A Patient With Terminal Stage of Hepatoma Suffering from Thanatophobia

本文描述一位肝癌末期病人因為疾病無法治癒而產生的無望感及死亡恐懼。護理期間為2011年7月17日至2011年8月9日，運用Gordon十一項健康功能型態為評估架構，藉由觀察、身體評估與會談等方式收集資料，確認個案主要的健康問題有1.組織灌流失效－－腸胃；2.慢性疼痛；3.無望感；4.死亡恐懼。在照護過程中，與個案建立信任關係，給予陪伴、傾聽、關懷，鼓勵表達內心想法並提供表達之機會，透過直接護理活動過程減輕個案在生理上的不適及接受治療，幫助個案能勇敢的面對未來。以藥物及非藥物治療減輕疼痛並由安寧共照團隊共同陪伴個案、傾聽內心的困擾，藉由禱告引導個案抒發憤怒、絕望、害怕、痛苦等負面情緒，接受死亡的可能並獲得心靈平靜。希望藉此護理經驗能提供照護臨床末期病人心靈需求的參考。

This article describes the sense of hopelessness and fear of death following awareness of the incurability of the disease in a patient with terminal hepatoma. The period of nursing care was from Jul. 17th to Aug. 9th 2011. Based on ”Gordon’s 11 Functional Health Patterns” as the framework for evaluation, data were collected through observation, physical evaluation and interviews. The major findings were: (1) Tissue perfusion failure – gastrointestinal, (2) Chronic pain, (3) Sense of hopelessness, and (4) Fear of death. During the nursing process, a relationship of mutual trust was gradually built. By being present, listening, caring, and providing opportunities for expression, the nurse encouraged the patient to express his inner feelings. Through therapeutic measures and direct nursing activities to alleviate physical discomfort, the patient received support in facing the future. Medicines and non-medical therapy alleviated the patient’s pain. With the assistance of the hospice care team, the patient’s inner torment was fully explored. Through prayer, the patient’s negative emotions, such as fury, despair, fear and agony were properly unleashed, and he accepted the inevitability of death. This nursing experience may serve as a reference for those who care for terminally ill patients.