照護一位口腔癌末期病人面對死亡之護理經驗

The Nursing Experience of Caring a Patient with Terminal Oral Cancer to Face Death

本文旨描述一位口腔癌末期病人面對死亡之護理經驗。護理期間自2010年11月4日至11月23日。筆者運用整體性護理評估進行病人身、心、社及靈性資料之收集，評估因病人疾病進展迅速、疼痛及面對死亡議題，引發病人與家屬哀傷，及病人心靈痛苦，確認病人有慢性疼痛、預期性哀傷、心靈困擾之健康問題。護理過程中藉身體評估、觀察、傾聽、筆談與病人及家屬建立互信關係，並運用安寧療護四全照護理念，提供病人個別性護理措施，採集中護理，並運用藥物及穴位按摩、頸部淋巴按摩及冰敷等輔助措施，減輕病人疼痛不適。並透過聯繫，取得陽光基金會及戶政事務所協助，讓住院中的病人在眾人見證下與女友完成結婚登記完成心願。同時在陪伴過程中除同理病人感受並協助其回顧過去，肯定其對家人的付出及一生努力；以找到人生意義與價值，並藉由社工師與宗教師的協助，運用宗教力量，讓病人了解死亡為自然歷程，透過念佛及皈依儀式，讓病人心靈安定及有所寄託，以達身體、心理及靈性平安之境界。藉由此護理照護經驗分享，作為日後照護末期病人之參考，並建議護理人員需持續充實安寧療護專業相關知能，以維持末期病人照護之品質，獲得自我心靈的成長。

This paper describes the experience for caring a patient with terminal oral cancer to face death. During the period of November 04, 2010 to November 23, author used the comprehensive nursing assessment to collect the patient’s physical, psychological, social, and spiritual information. Because of rapid progression of patient’s disease with pain and fear of death, the patient had spiritual pain and the family felt sorrow. Chronic pain, anticipatory grief, and spiritual distress were also identified. According to physical assessment, observation, listening, and communication by writing, author established a reliable relationship with patient and the family in the care process. To make use of the concept of palliative care with total care (holistic care, family care, team care, and continuing care), author provided patient an individualized care, centralized management, medical care, and complementary alternative therapies included acupressure, cervical lymph massage and ice packing, to reduce patient’s pain and discomfort. In addition, patient got marriage with his girlfriend in the ward by the assistance of Sunshine foundation and Department of Household Registration. During the process of author’s company, the patient was empathized for his feeling, reviewed his life, approved his efforts to the family, and found the meaning of his life. Besides, patient could understand that death is a natural course by the assistance of social worker and chaplain with the power of religion. Furthermore, through the Buddhist Scripture and the conversion ceremony, the patient had spiritual stability and sustenance and could achieve physical, mental and spiritual peace of the realm. By sharing this experience of nursing care, author hoped to provide a reference of the end of life care, and suggested that nurses should keep enriching professional knowledge of palliative care in order to maintain the quality of care of terminally ill patients and to obtain spiritual growth.