運用希望建立技巧於一位癌末無望感患者之照護經驗

Helping a Terminal Cancer Patient Establish Hope

癌症患者因患病過程及治療結果，會對未來生活產生無望感，而長期存在無望感可能導致死亡。個案是一位乳癌合併多處轉移之護理老師，患病初期曾積極配合治療，但在罹病一年內癌症仍多處轉移，因而無法接受疾病的快速惡化且對之前的治療經驗感到挫折，在住院期間出現被動、情緒低落、少語、情感反應減少、不參與治療、拒絕進食等負向行為。護理過程中以持續性照護及主動關懷與個案建立良好護病關係，運用希望建立之照護技巧，經由維持正向社交互動、提供相關醫療訊息、協助維持自我照顧、協助獲得心靈的平靜等護理措施，使個案對治療擁有正向態度、增加自我控制感並參與自我照顧及改善和他人的互動等，以調適疾病過程的變化，面對未來的生活。

Cancer patients who feel a sense of hopelessness concerning the prospects of long-term treatment success may defeat all efforts to stop their diseases. The authors present a case study of a breast cancer patient, a former nursing instructor, who suffered from passiveness, depression, resistance to communication, blunted affect, lack of participation in self-care, and refusal to eat-all resulting from a lack of treatment-related progress. One of the authors established a continuing and active care relationship with the patient. As part of her nursing care plan, she enacted encouraging social interactions, provided medical treatment information, assisted with self-care procedures, and attempted to maintain a constant level of psychological calm. Outcomes included an improved positive attitude toward treatment, enhanced self-control, active participation in self-care, and improved social interaction. The patient was also better able to adapt to her illness and to face an uncertain future.