一位乳癌末期患者生命終期之照護經驗

Experience of Caring a Patient in the Final Stage of Breast Cancer

本文描述一位乳癌末期合併肝和骨轉移的日籍大學助理教授在生命終期的照護經驗。照護期間為2016年11月3日至11月9日，運用觀察、身體評估及會談方式進行資料收集，並以Gordon十一項功能性健康形態進行整體性評估，確立個案有「低效性呼吸型態」、「慢性疼痛」、「心靈安適增進的準備度」等主要健康問題。照護期間主要提供個案藥物和非藥物的緩和療護措施，以緩解其呼吸困難、慢性疼痛等不適，促進舒適；另一方面也以傾聽、同理、陪伴、主動關懷，與個案建立良好的護病關係，引導個案表達其心願及討論死亡的準備，維護生命尊嚴，透過醫療團隊、醫院行政資源與個案任職的學校，共同協助個案完成最後一堂課之心願，協助圓夢，使得個案能夠放下、安心、不再牽掛，讓個案善終。藉此個案照護經驗分享，讓臨床護理人員能夠了解不同文化背景的生命終末期病人的照護需求，協助個案減輕臨終前的痛苦及完成遺願獲得善終，提升生命終末期照護品質。 The article described the nursing experience of caring a Japanese woman who was an assistant professor diagnosed with multiple liver and bone metastasis from breast cancer. The period of nursing care was from November 3 to November 9, 2016. The author used Gordon's 11 functional health patterns as the assessment framework and collected data through observation, physical assessment, and conversations. The health problems included ineffective breathing pattern, chronic pain, and readiness for enhanced spiritual well-being. We used medications and non-medical therapies to improve the patient's pain and dyspnea. In addition, we adopted the techniques of listening, empathy, accompaniment and active care to establish a good nurse-patient relationship, and encouraged the patient to express her feelings, and helped the patient realize her wish to finish the last class this semester and her post-mortem plans. We utilized team-work and community resources to help the patient have her wish came true at her terminal stage. These experiences can be shared as a reference for caring patients from different cultures and enhancing the quality of hospice care.