照護一位肺癌病人面臨生命末期之加護經驗

Nursing Experience of an End of Life Patient with Lung Cancer in an Intensive Care Unit

本文主要探討一位60歲肺癌末期病人，經歷呼吸窘迫、癌症疼痛之生理不適及面臨死亡哀傷，引發心靈困擾之加護病房照護經驗。照護期間由2009年8月24日至9月13日，筆者經由直接照護、傾聽關懷、溝通技巧、電子病歷、筆談、回顧照片等方式收集資料，並與個案建立信任之護病關係。藉由生理、心理、社會及靈性層面之評估，確立個案主要有呼吸道清除功能失效、疼痛、哀傷及心靈困擾之健康問題。照護過程主要秉持重症緩和療護工作理念，提供個別性護理措施：減輕痰液瘀積、運用疼痛控制技巧及舒適護理，緩解生理不適。藉由陪伴、傾聽、接納、分享並納入醫療團隊及安寧共照師，給予病人及家屬正確末期病情告知，讓個案參與生命末期之自主決策，符合意願的末期醫療照護；透過親友及宗教信仰支持系統，協助獲得心靈安適，使個案生命末期能在家人的陪伴下，尊嚴安祥的善終。

This article described the nursing experience of caring a terminally-ill patient with lung cancer in an intensive care unit. The patient suffered respiratory distress, cancer pain, discomfort, facing the distress and grief of dying. During the period from August 24, to September 13, 2009, the authors collected information and built up a trust relationship with the patient through caring, listening, communication, searching medical records, conversation, and reviewing photos. After assessing the physiological, psychological, social and spiritual problems, we founded main health problems were ineffective airway clearance, pain, grieving, and spiritual distress. By applying the spirit of palliative care philosophy in critical care, we provided individual care and interventions to reduce the sputum and pain while improving comfort. The medical team tried to communicate with patient and family members and obtained informed consent. The patient was able to make a decision autonomously for end-of-life care. Besides, we combined religious support system to improve spiritual well-being and move on to final journey of life, accompanied by his family members, expired with dignity and peace.