協助一位末期病人面對整體苦難之全人照護經驗

A Nursing Experience of Holistic Care on Total Suffering of a Patient with Terminal Illness

本文是描述以全人照護理念，協助一位末期病人面對身、心、靈及社會諸多層面錯綜交織的整體苦難之護理經驗。藉由實際參與照顧，運用觀察、同理心溝通技巧與整體性評估，統合出案主各層面分別有以下問題：（1）生理層面：以疼痛、噁心嘔吐進食量少、感染、高血鈣等四個問題為主；（2）心理社會層面：案兄獨自承擔照顧壓力身心俱疲、案主對住院費用之擔憂；（3）靈性層面：須感覺到神的同在與無條件的愛、苦難意義的追尋。進而訂定針對病人「量身訂做」的護理計畫進行活動，並依案主希望平安無痛苦往生之「餘生期待」為護理照護之目標。藉由積極協助症狀控制、鼓勵表達負面的情緒與感受、主動關懷同理照顧者其身心俱疲的壓力、透過藝術治療與至高者和解、幽谷伴行探尋苦難之意義，提供整體性、個別性與連續性照顧回應人性之需求。期冀此全人照護經驗能夠呼應Dame Cicely Saunders所言：「照護的給予可以深及隱藏的角落，並且為意想不到的成長提供空間」，提供相關醫護人員日後臨床照護的參考。

The purpose of this article was to describe a nursing experience using holistic care to relieve total suffering resulting from complex interactions amongst physical, psychological, social and spiritual aspects in a patient with terminal illness. Each aspect of problems was identified by means of direct participant care, observation, empathetic communication and holistic assessment. Such included: (1) physical aspect: distress caused by pain, nausea, vomiting and poor intake, infection and hypercalcaemia; (2) psychosocial aspect: caregiver's overwhelming burdens and financial concerns; (3) spiritual aspect: yearn for being with a higher-being and receiving unconditional love, pursuit of the meaning of suffering, proceed to the next stage to develop a unique care plan and nursing intervention program. Nursing goals were set up based on the patient's ”life expectancy” represented by the hope for a painless and peaceful death. The author helped to provide unique, holistic and continued care for the purpose of humanity. The main nursing interventions included active control of symptoms, encouraging the expression of emotional distress, caring and emotional resonance with caregiver's overwhelming burdens, reconciling with a higher being through art therapy, pursuit of the meaning of suffering and sharing the darkness. This nursing experience of holistic care may be shared with other healthcare professionals and has been recorded as a positive response to the following quote from Dame Cicely Saunders: ”The way care is given can reach the most hidden places and give space for unexpected development.”