一位被家屬通報死亡之乳癌病患之護理經驗

A Nurse's Experience Caring for a Patient with Breast Cancer Who had Been Previously Reported Dead by her Family

本文敘述一位四年前因失聯多年，被家人通報死亡後罹患乳癌的個案，因無法支付醫療費用，而面臨數次被轉院的照護過程。在照護期間以觀察、會談、身體評估等技巧收集資料，確立個案有「組織完整性受損、疼痛、經濟問題引發放棄治療的意念、對手足感到愧疚但又渴望親情支持」等四個健康問題。筆者運用Watson關懷理論與個案建立信任感，處理她的傷口問題，減緩疼痛，協助她與家人重新取得聯繫以恢復身分及獲得經濟支援，並協調轉至公立醫院接受政府的醫療補助，重新燃起個案對治療的期待與希望。然而，個案因必須再次轉院，引發安寧共照師在倫理道德方面的困擾，筆者與共照師會談，澄清轉院對個案的意義，協助其重新調整情緒，並繼續提供對個案的照護。本個案報告可作為在照顧「沒有身分」及人球事件病患時的參考，並提醒護理人員能在照護過程中早期察覺及適時協助處理其他醫療團隊人員的道德倫理困擾，以提供病患及家屬更完善的護理照顧品質。

This article describes the author's experience caring for a female with breast cancer who was reported dead by her family four years earlier due to a long-term disappearance. She had been transferred multiple times hospital to hospital due to inability to afford medical care. Data were collected via observations, interviews, and physical assessments. The author identified four primary problems, including impaired tissue integrity, pain, being compelled to abandon treatment due to financial status, desire for familial support, and sense of guilt toward her family. The author used Watson's Caring Theory to build trust with the patient and provided guidance on wound treatment, pain relief, and rebuilding family relationships in order to help restore the patient's identity and financial aid. As a result, the patient was able to transfer to a public hospital where she received free medical assistance and regained hope in her therapy. However, the palliative-care coordinator misinterpreted the referral and, as a result, experienced moral distress. After clarifying and explaining the meaning and importance of the patient referral, the coordinator accepted her and continued care. This case report can provide a reference for nurses caring for patients without personal identity or financial aid. Nurses should be aware of the presence of moral distress in other medical team members. Early recognition and timely management of team members' moral distress is fundamental to providing the best quality of care for patients and their families.