照顧一位初次罹患晚期肝內膽管癌患者的護理經驗

Nursing Experience of Caring for a Newly Diagnosed Advanced Cholangiocarcinoma Patient

本文旨在呈現一位45歲初次罹患晚期肝內膽管癌患者之照護經驗。護理期間自2017年 11月07日到2017年11月21日，以Gordon 11項功能評估個案健康問題有:疼痛、營養少於身 體所需、照顧者角色緊張。透過主動關懷、傾聽、陪伴建立關係，並協同多專科領域， 共同為個案及案妻改善上述健康問題，使用穴位按摩、正念數息輔助疼痛緩解；提供個 別化營養衛教並和備餐者共同討論個案喜愛餐點搭配以增加熱量的攝取；召開家庭會議 ，讓原生家庭成員瞭解目前病情及預後不佳，分擔照顧責任，引導案妻適時紓解照顧壓 力並與個案情感能有再連結。（志為護理，2020; 19:5, 121-130 ）

In this article, we present the nursing experience of caring for a newly diagnosed advanced cholangiocarcinoma patient. Gordon's 11 functional health assessments were used to collect data during the nursing period from November 07, 2017 to November 21, 2017. The nursing problems identified included pain, malnutrition, and caregiver role strain. We also established a well-ordering nurse-patient relationship through active care, listening, and providing company. We collaborated with a multidisciplinary team to improve these nursing problems. We provided acupressure and mindfulness to ease pain. We also assessed the factors of malnutrition and provided individualized diet education to increase calories. A family conference was arranged to convey information about the patient's condition and poor prognosis to his other family members, which allowed his wife to share some of the pressure of caregiving. We guided the patient's wife to remove some of the pressure of caring for the patient and reconnect emotionally with the patient. (Tzu Chi Nursing Journal, 2020; 19:5, 121-130)