運用Neuman理論照護一位大腸癌末期病人症狀困擾的護理經驗

Applying Neuman Theory in Caring for a Terminal Stage Colon Cancer Patient Experiencing Symptom Distress

本文運用Neuman系統模式為評估工具，照護一位大腸癌末期病人於住院期間面對因癌症產生之症狀困擾、社會及靈性層面壓力源的護理過程。筆者於照護個案期間運用觀察、身體評估及深度訪談收集資料，以了解個案個別需求。結果發現，影響個案產生症狀困擾的壓力源為：1.個案內壓力(intrapersonal stressors)：以食慾、疼痛、疲倦、憂鬱及體重下降的症狀困擾程度最高；2.個體間壓力(interpersonal stressors)：因面臨疾病變化、死亡威脅及家庭角色所背負的職責；3.個體外壓力(external stressors)：為缺乏社會經濟資源。在護理過程中筆者提供生理、心理、社會及靈性層面之照護，並協助個案形成對壓力源的抗阻能量。照護內容包括：緩解個案治療期間之症狀困擾；協助表達經驗、希望與想法，發揮家庭角色之功能及心理的重建；協助個案做有意義的生命回顧並降低死亡恐懼，坦然接受治療及面對生命的消逝，獲得有意義且高品質的照護。

The report describes the nursing experience of using Neuman system model to help a patient with symptom distress and faced social and spiritual stressors of the terminal stage of colon cancer. In the nursing process, the author collected information related to the patient’s needs through observations, physical assessment, and in-depth interview. Results indicated that sources of pressure affecting patient’s stress level included intrapersonal, interpersonal, and external stressors. Intrapersonal stressors included changes in physical symptom distress such as: anorexia, pain, fatigue, melancholy, and weight loss. Interpersonal stressors included facing the threat of disease change and death, and the responsibility of the family role that the patient assumed. External stressors included the lack of social-economical resources. Base on the Neuman System Model, the scope of nursing intervention included: mitigating the symptom distress during treatment; interpreting the experiences, wish and thoughts to exert the function of the family role and the re-creation of the mentality, helping the patient to retrospect her life with dignity and to reduce the fear about death, to face the fade-away of life calmly, and help the patient and his family obtain the best quality of life.