照顧一位子宮頸癌末期病人之照護經驗

A Nursing Experience of a Terminal Cervical Cancer Patient

本文探討一位婦女罹患子宮頸末期之臨終照護經驗，筆者護理期間2014年5月31日至2014年6月25日，運用身體評估、觀察以及會談方式收集資料，發現病人因腫瘤壓迫引起的疼痛，以及因傷口變化感到自卑及面臨死亡而產生焦慮。期間運用團隊專家（疼痛科、傷口護理師、社工、心理師、宗教師等）意見，多次會談整合病人及家屬不確定感及情感脈絡適時介入肯定生命意義等護理措施，以達到病人身、心、靈安適；對於病人面對死亡焦慮時，透過宗教力量和團隊適時介入引導四道人生，在家屬全程陪伴下，病人走向死亡時能感到身體安適、心裡平安，盼此次經驗分享能運用於日後照護之參考。

The article dThis article described a nursing experience of an end-stage lung cancer patient whowere resuscitated by CPR after severe allergic shock during chemotherapy and underwentendotracheal intubation combined with ventilator. Data were collected during the nursingperiod from 16th to 31st March, 2015, with Gordon’s 11 functional health assessmentas framework, via conversations by writing, interviews, and physical examinations. Thefollowing nursing issues were identified: impaired gas exchange, readiness for enhanceddecision making, and caregiver role strain. We built a positive nurse-patient relationshipthrough care and company, and reduced the anxiety of the family members by providingdisease information; successfully weaned the patient off of the ventilator and transferredout of ICU by assisting the patient with lung rehabilitation exercise. By employing theconcept of palliative care, the patient and the family were guided to face the importance ofdrafting advance directive, and to plan desired advance care planning. With the support andconsolation from family and religion, the patient attained spiritual comfort, returned homeand passed away in peace. We recommend all medical teams to guide end-stage cancerpatients in drafting advance directives as early as possible, and encouraescribed a terminal nursing experience of a female patient suffering fromterminal cervical cancer. The nursing period lasted from May 31 to June 25, 2014. Data werecollected by physical assessment, observation, and interview. The patient was identified withtumor-induced pain, low self-esteem from wound alteration, and death anxiety. During thenursing period, by integrating opinions from a interdisciplinary team (pain physician, woundcare nurse, social worker, psychologist, spiritual care worker), as well as sense of uncertaintyand emotional context of the patient and family members, timely nursing interventions wereimplemented to guide the patient in recognizing the meaning of life, and assist the patientin achieving physiological, psychological, and spiritual comfort. When accompanying thepatient in facing death anxiety, a timely religious and interdisciplinary interventions wereintroduced four themes of life (gratitude, apology, love, and farewell) With the company ofthe family members throughout the nursing period, the patient was able to achieve physicaland psychological comfort as she approached the end of her life. We hope this experiencecan serve as a future nursing reference.