一位末期骨肉瘤青少年接受安寧照護之照護經驗

The Hospice Nursing Experience of a Young Adult Patient With Osteosarcoma

本文敘述一位青少年骨肉瘤末期病人之照護過程，由於父母愛子心切而隱瞞實際病況，直至面臨死亡前夕才獲知實際狀況，加上家人不捨的情感衝擊，最後運用安寧照護理念獲得善終之照護經驗。筆者於2015年10月20日至10月26護理期間，針對身心靈、社會做整體性評估，藉由觀察、會談、直接照顧、病歷查閱、團隊討論及電話訪問收集資料，確定個案護理問題包括「疼痛/與骨腫瘤壓迫及疼痛控制藥物劑量不足有關」、「死亡焦慮/逃避臨終議題與無法面對死亡有關」及「預期性哀傷/與個案瀕臨死亡及未有適當死亡準備有關」。照護過程中，運用安寧照護理念，經由傾聽關懷、同理支持，以護理專業協助緩解生理上不適；並善加運用學校同儕及師長的支持力量，降低個案死亡焦慮，獲得身體、心理、靈性三平安；採個別性輔導家屬，鼓勵抒發哀傷，一同陪伴完成心願規劃，終能促使家人間情感凝聚，共同面對善終歷程。建議未來能依據實證文獻整合結果，發展出適合本土化的青少年安寧緩和照護標準，供臨床人員照護參考。

This paper describes the hospice care for a young patient with osteosarcoma who was unaware of his actual condition until death drew near as his parents had concealed his situation. Physical, spiritual, and social evaluations were conducted from October 20 to 26, 2015. Data were collected through observations, conversations, direct care, review of medical records, team discussion, and telephone interviews. It was determined that the patient suffered from pain due to bone tumor pressure and medication underdosing, death anxiety from being unable to face the topic, and emotional impact from family due to impending and poor preparing for approaching death. During the period of care, concern, listening, empathy, and support were used to relieve physical discomfort. Support from school peers and teachers helped reduce death anxiety and achieve physical, psychological, and spiritual peace. Individualized family care encouraged expression of grief and the desire to accompany each other in order to unite the family and face the dying process. It is suggested that similar literature can be consulted to develop hospice and palliative care standards for young adults to serve as a reference for clinical care providers.