照顧一位肝癌末期病人接受臨床試驗失敗之護理經驗

The Nursing Experience of a Patient with Advanced stage of Hepatocellular Carcinoma after Failing the Clinical Trial

本文探討一位肝癌末期病人接受藥物臨床試驗失敗後，承受生、心理衝擊之護理過程，個案於2015年9月29日至10月28日住院治療，運用Gordon十一項健康功能評估型態進行整體性評估，藉由直接觀察、會談、身體評估等方式收集資料，歸納確立因疾病惡化，個案有癌症疼痛、體液容積過量及下肢淋巴水腫與無望感等健康問題。提供合宜護理照護改善個案症狀困擾，包含疼痛處置-藥物及非藥物方法，精油按摩及下肢淋巴按摩等措施。此外，提供心理支持，整合安寧團隊共同照護，執行個案的生命回顧，體悟生命意義與價值，與家人及重要朋友進行最後道別，最後完成個案臨終返家心願及善終目的。期望藉此接受臨床試驗失敗的護理經驗分享，提供護理人員臨床照護之參考。

The article was to describe the nursing experience of a patient with advanced stage of hepatocellular carcinoma (HCC), who suffered from a high level of physical and psychological distress after failing cancer clinical trial from 29 September to 28 October, 2015. Gordon's 11 healthy functional patterns were used to assess his health problems through observation, interviewing, and physical examination. Problems included cancer pain, fluid overload-ascites and limb lymphedema, and hopelessness due to the rapid progressive disease. We provided nursing care to improve his symptom distress, including analgesics, non-pharmacological pain management, aromatherapy with massage, and decongestive therapy of limb lymphedema. Moreover, psychological supports were provided, including integrating the hospice and palliative shared care team, doing patient's life review, understanding the meaning of life and the value of life, and termination-goodbyes to family members and important friends. Finally, his last wish with hospice-dying at home and the purpose of having a Good Dying were completed. We expected to provide this nursing experience in caring for patients who fail the clinical trial as a reference for nurses.