運用舒適護理於大腸癌合併庫肯勃氏腫瘤臨終患者之護理經驗

Comfort Nursing In a Terminal Colon Cancer Women with Krukenberg’s Syndrom

本文是描述一位大腸癌合併庫肯勃氏腫瘤臨終的年輕女性，面臨病痛和死亡威脅等多重衝擊，衍生身心靈社會整體焦慮不適及痛苦。筆者於2012年10月30日至2012年11月7日照護期間，運用舒適護理模式評估病患，發現個案的舒適問題有「多部位性疼痛」、「身體心像紊亂」及「死亡焦慮」。護理過程藉由舒適護理之多面性及個別性緩解個案整體性的疼痛，並透過關係建立，進行溝通、支持、功能維持、症狀緩解、心靈活動及舒適活動(按摩、音樂治療及接觸大自然)，緩解病患身心靈社會整體層面的不舒適，進而以四道人生得到自在和超越的需求，讓臨終患者的生活品質獲得整體安寧滿足，並期望達到安適善終之護理目標。護理過程中筆者深感護理人員除需具備良好的態度，還需具有熟練豐富的知識技能，如生命存活期及疾病軌線的預估等，早期介入使安寧臨終照護品質更臻完善，建議加強臨終實證護理及癌症末期照護之相關教育訓練提升護理照護之技能，提供以患者為中心的獨特性護理，確保病患能獲得完善的照護品質。

This paper described the physical, mental, spiritual, and social anxiety, stress, and pain experienced by a young female patient with colon cancer and Krukenberg tumors while dealing with pain and the threat of death. The author provided comfort care between October 30, 2012 and November 7, 2012 and found that the patient suffered from pain in multiple regions, body image disturbance, and death anxiety. The comfort care eased the patients overall pain. After establishing a relationship with the patient, communication, support, functional and symptom management, and spiritual and relaxing activities (such as massage, music therapy, and contact with nature) were used to ease the patients physical, mental, spiritual, and social discomfort. Tranquility was achieved through expression of gratitude, love, apology, and parting, improving the patients quality of life and effectively executing end-of-life care. It was found that nurses must be trained in a wide range of skills in addition to having a good attitude; for example, estimation of survival and illness trajectory. Early intervention can improve the quality of end-of-life care. Nurses should improve end-of-life care and end-stage cancer care skills to provide patient-centered and individualized care, ensuring the highest quality of patient care.