照護初次診斷肝癌末期個案之護理經驗

A Nursing Experience of a Patient Diagnosed with Terminal Stage Hepatocellular Carcinoma

本文探討一位初次診斷肝癌末期個案，面對罹癌又無法進行治癒性治療，進而產生因疾病、治療過程中衍生的生理、心理不適等問題，護理期間自2012 年11 月10 日至11 月22 日，筆者透過直接照護、身體評估、觀察、會談等方式，運用Gordon 十一項健康功能型態進行整體性評估及資料分析後，確立有疼痛、焦慮及無望感等三項健康問題。筆者於護理過程中藉由正確的疼痛評估，給予止痛藥物控制及另類療法如穴位按壓、精油按摩減輕個案的疼痛不適。透過不斷傾聽、溝通，以同理個案及家屬的感受並回覆示教緩解焦慮，如轉移注意力、按摩配合輕柔音樂、引導宗教信仰的介入等措施，以降低焦慮。與個案建立良好護病關係，協助個案罹病事實，鼓勵家庭支持，以利個案有正向態度來維持個案的希望。期許此護理經驗能夠提供護理同仁往後照護類似個案之參考。

This article describes the nursing experience of a patient diagnosed with terminal stage hepatocellular carcinoma (HCC). He had experienced both physical and psychological discomfort during hospitalization. Nursing care was provided from November 10th to 22nd, 2012. The author collected data through direct care, physical assessment, close observation, and interviews. Gordon’s 11 functional health patterns were served as a framework for gathering and analyzing information. The results revealed three major health problems: pain, anxiety, and a sense of hopelessness. During the nursing process, the author administered the analgesic medication based on pain assessment, and offered alternative therapy such as acupuncture point massage and relaxation techniques to mitigate the patient’s discomfort and pain. With active listening and consistent communication, the authors made efforts to understand and empathize with the patient and family’s feelings and perspectives. In addition, the author educated the patient and family members the methods to shift attention away from anxiety and the therapy to massage with soft music, and provided intervention of religious and so on to continue nursing care. By establishing a therapeutic relationship with the patient, the author not only helped the patient to accept the diagnosis with hepatocellular carcinoma, but also developed a family support system, for increasing the patient’s positive attitude and fostering a sense of hope and optimism towards his disease.