運用關懷理論照護一位大腸癌合併肺轉移末期病人身心受苦之護理經驗

Nursing Experience Involving the Application of Caring Theory to Terminal Patients with Colon Cancer Combined Lung Metastases who was Experiencing Physical and Mental Suffering

本文為運用關懷理論照顧一位大腸癌合併肺部轉移個案，於生命末期面臨身心受苦之護理經驗。照護期間為2018年11月13日至2018年11月23日，藉由觀察、會談、身體評估方式進行身體、心理、社會、靈性之整體性評估，確立個案有低效性呼吸型態、皮膚完整性受損及情境性低自尊之健康問題，運用Swanson關懷理論了解、在旁陪伴、為他做某些事、使他能夠與維持信念五大過程，透過持續地提供關懷照護了解個案對症狀的看法，協助使用非侵入性正壓呼吸器、教導噘嘴呼吸、分散注意力、舒適臥位及口腔護理，降低個案呼吸喘的感受；給予適當的翻身、下肢抬高、減壓床墊及合適的敷料使用以改善其下肢水腫及壓瘡；引導家屬與個案共同回顧過去重要與美好的事件，使其彼此互相感謝過去的歲月，讓個案平靜度過生命最後階段，解決個案身心受苦之問題，進而達到安適。期望透過此照護經驗，使護理人員可以提早發現病人身心需求，提供整體性之全人照護，使病人能平靜的走完人生旅程，達到病人與家屬生死兩相安。

This report described the experience of applying Swanson’s Caring Theory to a terminal patient with colon cancer combined lung metastases who was experiencing physical and mental suffering. We used overall assessments that include physical, psychological, social, and spiritual domains to collect data through observation, interviews, and physical assessments during the period between November 13 and 23, 2018. The health problems of the patient included ineffective breathing patterns, impaired skin integrity, and low situational self-esteem. We applied aspects from Swanson’s theory, such as“knowing,” “being with,”“doing for,”“enabling,”and“maintaining belief,”in order to provide continuous care to the patient. We used bi-level positive airway pressure (BiPAP), pursed lip breathing, distraction, comfortable positioning, and oral care to relieve the patient’s experience of shortness of breath. We used appropriate rollover, limb lift, a pressure-relieving device, and suitable dressing to reduce the patient’s lower extremity edema and pressure sores. We also encouraged and guided the family and the patient to review the important and beautiful past events with each other; then, the patient was able to spend the final stages of life peacefully. This case report can be used as a reference to help nursing staff recognize the patient’s physical, psychosocial, and spiritual needs sooner. In this way, the nursing staff can provide holistic care to help the patient complete the journey of life calmly.