運用安寧理念照護一位肝癌末期病人的護理經驗

Hospice Care Nursing Experience Related to a Patient with Terminal Stage Liver Cancer

本個案報告是依Neuman系統模式做為評估工具，運用安寧照護理念照護一位肝細胞癌末期病人的護理過程。在護理過程中筆者先與個案建立信任的關係，再藉由溝通、觀察及病歷收集資料，以了解個案身、心、靈的需求。結果發現，影響個案個人功能系統和諧進展的壓力源分別來自於個案內在之：(1)個體內壓力(intrapersonal stressors)：包括營養狀況改變、疼痛與面臨死亡的恐懼與掙扎；以及(2)個體間壓力(interpersonal stressor)：因面臨死亡而無法完成家人期待而引發的愧疚與自責。依據TheNeuman System Model分析個案壓力源，採三級預防的理念介入，協助個案形成對壓力源的抗阻能量。介入內容分為(1)透過安寧照護理念緩解個案末期疼痛及腹水所帶來的疼痛與營養問題；(2)提供心理及靈性層面的照顧，幫助個案降低死亡恐懼及做有意義的生命回顧；(3)協助個案和家屬在生命末期階段能獲得最佳生活品質，充分發揮家庭功能。最後個案在家人的陪伴下，尊嚴、安詳、沒有痛苦的劃下人生句點。

This case report describes hospice care provided to a patient suffering from terminal stage liver cancer. Care was analyzed based on the Neuman System Model. In the nursing process, the author first established a good relationship with the patient and then collected information related to patient physical, mental and spiritual needs through discussions, observations and anamnesis. Results revealed that sources of pressure affecting patient functional system harmony came from two intrinsic factors; namely, intrapersonal and interpersonal stressors. Intrapersonal stressors included changes in nutritional status, aches, and struggles with/fear of death. Interpersonal stressors addressed the guilt of being unable to meet the expectations of family members. Based on the Neuman System Model, patient pressures were analyzed at three levels of prevention in order to strengthen their ability to cope. The scope of intervention included (1) alleviate problems of aches and malnutrition resulting from abdominal dropsy in the terminal stage of cancer; (2) provide psychological and spiritual care in order to ease patient fears of death and encourage positive reflection on life; (3) position the family to perform a positive role to help the patient and his family obtain the best quality of life. The patient finally passed away in the company of his family in a dignified, peaceful and painless manner.