照顧一位胃癌末期臨終病患之護理經驗

A Nurse's Experience of Caring for a Gastric Cancer Patient at Terminal Stage

本文為一位正值中年期，被診斷為胃癌末期臨終病患之護理經驗。個案因疾病進展逐漸惡化，除了身體症狀導致不適外，在即將面臨死亡及與家人分離的情境，產生心靈的不平安。筆者透過觀察、會談等方式收集資料，護理期間為2015年的月02日至2015年的月10日，以Gordon十一項功能性健康型態進行評估，確立護理問題為：疲憊、疼痛、心靈困擾及預期性哀傷。照護過程中，因疾病症狀影響日常生活作息及睡眠所引發的疲憊感受，除藉由藥物改善外，調整每日作息與活動峙間，鼓勵適當活動改善睡眠品質，減少疲憊狀況發生。在身體上的疼痛除了藥物控制外，藉由輔助方式，如：精油按摩以緩解疼痛感受，增加舒適感。在心靈上的困擾，運用傾聽、陪伴，引導（個案與其信仰的神重新修復關係，恢復參與宗教活動，獲得心靈安適。預期性的哀傷則透過引導個案及家屬，在臨終階段完成與家人道謝、道歉、道愛、道別的四道人生，達到生死兩相安。建議安寧團隊能放癌末個案治療效果有限時即行介入，讓病患與家屬及早獲得高品質的照護，期待本文之經驗能提供給未來照護類似個案之護理同仁參考。 This article describes a nursing experience of caring a middle age patient with gastric cancer at the terminal stage. The patient's condition badly progressed, not only experiencing physical discomfort but also facing the threatening of death and separating with families. Data were collected through observation and interviews during the period between May 01 and May 10, 2015. Gordon's 11 Functional Health Patterns were utilized to identify the patient's nursing problems, which were: fatigue, pain, spiritual distress, and anticipatory grieving. In order to dealing with fatigue, nurses and patient discussed and reorganized the daily schedule. Medication and essential oil massage was used to relieve pain. To resolve the problem of spiritual distress, the nurse applied the communication skills, such as: listening, accompany with the patient to help to repair the relationship between the patient and his God. Moreover, the patient took part the religious activities and finally achieved spiritual wellness. To accomplish the four themes of life of Buddhism beliefs, the nurse guided the patient and his families to express gratitude, apology, love and goodbye, which helped them to adapt anticipatory grieving. In order to provide high quality of care, it was suggested that the hospice care team can provide help as early as possible while it is limited to cure the disease. We hope this nursing experience provides some guidelines for nurses who care the patients with similar conditions.

This article describes a nursing experience of caring a middle age patient with gastric cancer at the terminal stage. The patient's condition badly progressed, not only experiencing physical discomfort but also facing the threatening of death and separating with families. Data were collected through observation and interviews during the period between May 01 and May 10, 2015. Gordon's 11 Functional Health Patterns were utilized to identify the patient's nursing problems, which were: fatigue, pain, spiritual distress, and anticipatory grieving. In order to dealing with fatigue, nurses and patient discussed and reorganized the daily schedule. Medication and essential oil massage was used to relieve pain. To resolve the problem of spiritual distress, the nurse applied the communication skills, such as: listening, accompany with the patient to help to repair the relationship between the patient and his God. Moreover, the patient took part the religious activities and finally achieved spiritual wellness. To accomplish the four themes of life of Buddhism beliefs, the nurse guided the patient and his families to express gratitude, apology, love and goodbye, which helped them to adapt anticipatory grieving. In order to provide high quality of care, it was suggested that the hospice care team can provide help as early as possible while it is limited to cure the disease. We hope this nursing experience provides some guidelines for nurses who care the patients with similar conditions.