提供一位癌症末期病人安寧療護之經驗

An Experience Providing Hospice Care to a Terminal Cancer Patient

本文探討一位57歲晚期唾液腺癌個案安寧療護之照護經驗，護理期間自2017年6月1日至6月28日，依生理、心理、社會與靈性四大層面進行整體性的護理評估，確認個案主要有慢性疼痛、家庭運作過程失常與靈性困擾等三項健康問題。照護過程運用有效的疼痛處置穩定病人的身體狀況，轉介安寧共同照護團隊共同合作，協助個案與家人修復家庭關係，並協助完成眼角膜捐贈心願，尋找存在的意義並達成善終的過程。在臨床實務上建議可將眼角膜捐贈說明納入常規安寧照護衛教指導中，而對於照護方面，建議護理人員遇到類似個案除適時轉介相關醫療團隊外，平常亦可多參與器官捐贈的相關課程，培養正向態度及哀傷輔導技巧，以具備足夠的專業、信心、耐心及器官捐贈勸募技巧來照護此類病人，提升末期照護品質。期望藉此護理經驗分享，提供護理人員日後照顧癌症末期病人之參考。 This study discusses a case in which corneal-donation care was provided to a 57-year-old patient with terminal salivary gland cancer. Nursing care was provided from June 1 to June 28, 2017. The overall nursing assessment (covering physiological, psychological, social, and spiritual aspects) confirmed that the three main issues faced by the patient were chronic pain, dysfunctional family processes, and spiritual disturbances. Effective pain treatment was applied during the care process in order to stabilize the patient's physical condition. A hospice shared care team then worked together to help the patient mend his relationships with family members, fulfill his wish to donate his cornea, find meaning in his life, affirm his contribution to his family and society, and die a peaceful death. With regard to clinical practice, an explanation of corneal donation should be included in the conventional educational guidelines for hospice care. In addition to referrals to the relevant medical teams, it is recommended that nursing personnel who deal with patients like this participate in organ donation courses and develop positive attitudes and grief counseling skills. These actions will enable them to build up the professionalism, confidence, patience, and organ procurement-related skills required for the provision of care to these patients, which will in turn lead to better-quality palliative care. It is hoped that the nursing experience shared herein provides nursing personnel with a reference for palliative cancer care.