運用關懷理論於一位口腔癌末期病人之護理經驗

A Nursing Experience Applying the Watson's Caring Theory to a Patient with Terminal Oral Cancer

癌症末期病人不僅身、心、靈各方面面臨痛苦，隨著疾病的惡化，家庭成員內心也會遭受到衝擊。本文在分享運用Watson關懷理論於一位診斷口腔癌末期病人之護理經驗，個案於住院期間發現癌症已轉移且生命期只剩六個月，藉由觀察、會談與實際照顧個案，運用Watson關懷理論進行整體性護理評估及健康問題之收集，發現主要健康問題有低效性呼吸型態、無望感、心靈困擾，主要照顧者有預期性哀傷之護理問題，護理過程中生理方面提供涼爽的室內空氣，藉由正確呼吸訓練，改善通氣狀態維持足夠氧合，心理方面藉著傾聽，鼓勵表達其內心感受，經由親手抄寫佛經及聽宗教音樂，至佛堂膜拜來滿足宗教上的需求，減輕個案心中不安；與家人、朋友談天互動中做有意義的生命的回顧；協調轉介社工師，提供家屬面臨個案可能死亡之哀傷照護與諮詢，運用同理心關懷與支持，個案出院返家後，藉由電話得知個案非常珍惜與家人相處的每一天，正向面對即將死亡事實及自行安排往生之事宜。希望藉由此護理經驗提供臨床護理人員發揮全人照顧的角色，以提供末期病人完善的照護。

Terminal cancer patients suffer at the physical, psychological and spiritual levels. As the patient deteriorates, family members also experience psychological shock. In this article, we share our nursing experience in applying the Watson's Caring Theory to a patient diagnosed with terminal oral cancer. During the patient’s hospitalization the cancer was found to have metastasized and the patient had a life expectancy of six months. By observing, interviewing and taking care of the patient, we employed the Watson’s Caring Theory to perform a comprehensive nursing assessment and to collect health problems. We found that the main health problems included ineffective breathing pattern, hopelessness and spiritual distress for the patient as well as anticipatory grief experienced by main caregivers. For the physical aspects, we improved ventilation and maintained adequate oxygenation by providing the patient with cool indoor air and correct breathing training. For the psychological aspects, we listened and encouraged the patient to express inner feelings. For the spiritual aspects, we suggested the patient hand-copy Buddhist scriptures, listen to religious music and worship at a temple that meets religious needs to reduce uneasiness. In addition, we undertook a meaningful review of the patient’s life through conversation and interaction with family and friends. We referred the family to social workers who offered grief care and counseling in facing the patient’s possible death. We followed up on the case with empathic care and support through a phone call after the patient returned home. The patient cherished each day with the family, positively accepted the fact of impending death and made funeral arrangements in advance. We hope this nursing experience will assist clinic nurses in providing holistic care for terminally ill patients.