照顧一位急性淋巴性白血病末期病患之護理經驗

Nursing Experience of Caring for a Patient with Terminal Acute Lymphoblastic Leukemia

探討一位T細胞急性淋巴性白血病末期病患，面對癌細胞侵犯中樞神經，導致死亡威脅所承受身心痛苦之護理經驗，照護期間為2016年8月29日至2016年9月30日，運用Gordon十一項功能性健康評估收集資料，發現病患有疼痛、口腔黏膜改變及預期性哀傷，護理過程中，藉由藝術及音樂療法使身心放鬆，提供舒適擺位及穴位按摩，降低疼痛感；口腔潰瘍情形給予協助口腔護理清潔，促進傷口癒合，幫助病患減輕身體不適，以同理心陪伴繪畫，鼓勵表達內心感受，透過畫冊及照片帶領回顧生命，藉由醫療團隊及宗教支持幫助下，完成與朋友及家屬道謝的心願，使病患坦然面對死亡及臨終準備，達到生死兩相安。

This study investigates the nursing experience of caring for a patient with terminal acute T-cell lymphoblastic leukemia facing the death threat and physical and psychological suffering caused by cancer cell invasion of central nervous system. The author cared for the patient from August 29th, 2016 to September 30th, 2016, and used Gordon's 11 Functional Health Patterns Assessment to collect data. This study found that the patient experienced pain, oral mucosal changes, and expected sadness. During the nursing process, the author used art and music therapy to enable the patient to achieve physical and psychological relaxation and provide the patient with comfortable positions and acupressure to reduce pain. The author assisted the patient in caring and cleaning mouth to relieve oral ulcers, improve wound healing, and help patient alleviate physical discomforts. The author accompanied the patient on painting with empathy, encouraged the patient to express inner feelings, and guided the patient to review life through painting albums and pictures. Under the assistance of medical team and religious support, the patient fulfilled the wish to express gratitude to friends and family and faced death and preparation for death calmly, which achieved peace for both the dead and the living.