一位卵巢癌末期病人之臨終照護經驗

Hospice Care Experience for a Patient with Advanced Ovarian Cancer

本文在探討一位卵巢癌末期病人之臨終照護經驗。護理期間為2016年11月13日至2016年12月8日，運用Gordon十一項功能健康型態進行整體評估，經直接照護、會談、身體評估及查閱病歷紀錄方式收集資料，確立個案有「體液容積過量」、「慢性疼痛」、「無望感」及「預期性哀傷」四項護理問題。護理過程中，照護團隊在安寧共照團隊的協助下，藉由提供止痛劑及非藥物的輔助療法，協助個案維持舒適臥位，給予淋巴水腫按摩，緩解個案體液容積過量及疼痛問題；運用回顧生命方式，讓個案重整生命的過程，協助個案接受疾病末期及接受放棄心肺復甦術善終想法，勇敢面對死亡與後事交代，改善無望感的問題；依循治療照護計畫，引導並陪伴個案向其家屬及男友說出心中感受，互相道謝、道歉、道愛及道別，完成四道人生，渡過哀傷過程，協助個案及家屬正向面對臨終過程以達善終，使個案及家屬生死兩相安。

This work explores the experience of hospice care for a patient with advanced ovarian cancer. The period of care was from November 13 to December 8, 2016. Gordon's 11 functional health patterns were applied for overall assessment. Data were collected through direct care, interviews, physical assessments, and review of medical records. The case was confirmed to have four nursing problems, namely, excess fluid volume, chronic pain, hopelessness, and anticipatory grief. During the nursing process, the care team assisted the patient in maintaining a comfortable lying position by providing analgesics and nonmedicinal adjuvant therapy, with the assistance of the hospice team. Massages were provided for lymphedema, to alleviate the patient's pain and release excess fluid volume. Based on the retrospective approach to life, the patient was allowed to reorganize her life process. This helped the patient in accepting the terminal stage of the disease, giving up cardiopulmonary resuscitation to have a decent death, courageously facing death, and giving final instructions, thereby relieving the patient's feeling of hopelessness. Following the treatment and care plan, the patient was guided and accompanied to tell her family and significant other about her feelings. They could thank, apologize, express love, and say goodbye to each other, completing the four stages of grieving. This process helped the patient and her family positively face the dying process and achieve a decent death; thus, the patient and her family members were all comforted.