一位拒絕治療鼻咽癌末期患者之加護護理經驗

Caring for a Terminal Patient with Nasopharyngeal Carcinoma in the ICU Who Refuses Treatment: A Nurse's Experience

本文描述一位鼻咽癌末期患者面對腫瘤出血仍不願就醫，在意識昏迷時由家人送入醫院求診。在加護病房治療期間，個案對疾病的惡化及家人關係的緊張，而產生冷漠、被動、憤怒的情緒，拒絕接受任何治療及照護的護理經驗。筆者於2007年5月9日至2007年5月23日護理期間以觀察、身體評估、會談及筆談等技巧收集資料，歸納出個案有營養不均衡：少於身體所需、無望感、焦慮等護理問題。在護理過程中運用Watson關懷理論與個案建立信任感，提供疾病相關資訊協助個案坦然面對，在家人的支持中重新尋找希望，協助個案與他人互動，肯定自我價值，進而願意主動參與自我照護。藉由此次照護經驗，期望能提供護理人員在照護類似病人的參考與運用。

This article describes the experience of a nurse directly responsible for the care of a patient with terminal stage nasopharyngeal carcinoma who refused all medical treatment. Tumor bleeding had caused loss of consciousness, which led to the family arranging ICU admission. While in the ICU, the patient was overwhelmed by feelings of hopelessness regarding his disease and believed his family was not emotionally supportive. The patient was verbally non-responsive, angry and lethargic. He also refused to accept any medical care or treatment. The author collected data through observation, physical assessment, interviews and written communication between May 9th, 2007 and May 23rd, 2007. The author confirmed the diagnosis and found that the patient had some related mental health problems, including imbalanced nutrition (less than body requirements), chronic feelings of hopelessness and anxiety. The author established a positive relationship with the patient utilizing Watson's caring theory and case-establishment trust in the nursing process. The author provided disease-related information to the patient, worked as an intermediary to encourage greater family member support and encouragement, helped the patient interact with visitors and encouraged development of the patient's self-esteem. This experience can benefit nursing professionals by fostering a greater understanding of patient self-esteem and the benefits of a positive treatment environment.