運用善終概念協助肝癌末期病人家屬決策歷程之護理經驗

Nursing Experience of Assisting Hospice Care Decision Making for Families of a Terminally-Ill Liver Cancer Patient

本文旨在運用善終概念，照護一位肝癌末期病人之家屬，其調適面對臨終情感衝擊、化解決策衝突之歷程。筆者照護期間2017年2月24日至3月9日，運用觀察、會談及病歷查閱收集資料進行評估，確立護理問題為：舒適型態改變╱疾病進展惡化與醫療處置導致、決策衝突╱家屬矛盾情感相關、預期性哀傷╱家屬面臨即將失去病人與不捨病人身體受苦等主要護理問題。護理過程中筆者運用善終概念照護病人及家屬，以臨終者善終：協助減輕病人疼痛不適與增加舒適；以失親者善別與在世者善生，陪伴關懷家屬哀傷情緒，給予哀傷支持協助調適，最終引領家屬於情感糾葛中釋懷平安，在家屬面對決策困境當中讓病人善終平安，達到真正的生死兩相安。

This article addresses the concept of hospice for the families of patients with liver cancer, adjustments to end-of-life emotional effects, and solving decision conflicts. Nursing care was provided from February 24th to March 9th, 2017. Data were collected through observation, interviews, and reviews of medical records. The following nursing problems were determined: changes in comfort caused by disease progression and medical treatment; decision conflicts caused by emotional family members; and anticipatory grief caused the patient's impending death. During the nursing experience, the author used the concept of hospice care with patients and family members. Grieving families should be provided with support; patients should be allowed a good death; and patients' body pain should be reduced when families experience decision conflicts.