運用Swanson關懷理論於一位惡性腫瘤末期病人行眼角膜捐贈之護理經驗

Nursing Experience for a Corneal Donating a Late-Stage Malignant Brain Tumor Patient Using Swanson Care Theory

本文運用Swanson關懷理論於一位惡性腦瘤末期病人，接受行眼角膜捐贈護理經驗，於2015年10月22日至11月3日，依整體性護理評估，透過直接照護、溝通及觀察等方式收集資料，評估病人生理、心理、社會及靈性各層面，確立病人有顱內壓調適能力降低、呼吸道清除功能失效、哀傷及抉擇衝突之健康問題。利用Swanson關懷照護理論，於照護過程中以減少外在刺激、避免體溫增高，以降低顱內壓，減緩其不適及穩定生命徵象為優先，因自咳能力差，執行背部叩擊及口腔護理，以降低肺炎發生率，恢復正常呼吸音，維持呼吸道通暢，病人預定器官捐贈，讓家屬感到猶豫及不捨，經醫療團隊召開家庭會議，透過關懷、鼓勵表達內心感受，提供所需訊息及資源，以降低抉擇衝突，並正向態度接受病人遺願，以達生心理、靈性完整性照護，期望藉由此次照護經驗，加強醫護對於器官捐贈的知能，增進溝通協調的能力，並協助家屬哀傷情緒的處理，期望使更多生命末期病人及家屬皆能達到生死兩相安，能更舒適及有尊嚴的善終。

An experience of using the Swanson Care Theory was used to diagnose and treat a corneal donation patient with a late-stage malignant brain tumor. From October 22 to November 3, 2015, the data were collected through direct care, communication and observation, to value patient's mental and physical state. We know that the patient got expected sadness, the choice of conflict health problems, and decreased intracranial adaptive capacity. In order to reduce the incidence of pneumonia, it is necessary to reduce external stimuli and avoid increased body temperature in the care process to reduce intracranial pressure, to relieve discomfort and stabilize vital signs, and to perform back tapping and oral care because of poor self-cough ability. The patient restored normal breath sounds and maintained airway patency; Organ donation also hesitated patient family, which led to choice difficulty. Our medical team held two family meetings. Through care, encouraging the expression of inner feelings and offering information and resources, we successfully reduced the choice of conflict and had a positive attitude to accept the loss of their facts of their beloved and achieve psychological and mental integrity care, to enhance the ability to communicated and coordinate, and to help the treatment of sadness, which could eventually achieve inner peace and best ending for both living and death. It is expected that by sharing this care experience, this study could provide the caretaker more information on the issue.