運用安寧緩和療護於一位肝癌末期病人之照護經驗

Nursing Experiences of the Hospice and Palliative Care for a Liver Cancer Patient in Terminal Stage

本報告乃探討一位肝癌末期個案於接受安寧療護後獲得身、心、靈照護之經驗。照護期間自2014年11月27日至2014年12月23日，筆者透過身體評估、會談、傾聽、觀察家庭互動及運用安寧團隊照護等方式，以整體性護理評估為架構，進行個案身、心、社、靈等層面的評估。並確立個案有慢性疼痛、預期性哀傷、心靈困擾等問題。護理措施乃透過藥物的投與，以及輔助療法來減輕個案的疼痛症狀；同時透過建立良好的護病關係及治療性溝通，主動傾聽、陪伴及支持，鼓勵個案提出預期性哀傷、失落的感受與需求，引導家屬正視個案想返家之心願，協助圓夢。並運用會談、輔導及透過生命回顧等循序漸的方式協助其尋找生命意義，肯定其對家人的付出及一生努力，藉以找到人生意義與價值；透過社工師與牧靈人員的協助，讓個案了解死亡為自然歷程，使個案在住院期間，有勇氣面對、接受、並準備自己的死亡獲得心靈平靜。藉由本文探討肝癌末期個案身、心、靈之護理過程，作為日後照護末期病人之參考，並建議護理人員需持續充實安寧療護專業相關知能，以維持末期病人照護之品質，獲得自我心靈的成長。

This report described the nursing experiences of a terminal liver cancer patient who has received physical, psychological, and spiritual care in the hospice. During November 27 to December 23, 2014, I performed the physical, psychosocial, and spiritual assessments through the hospice care techniques, such as physical examination, talking, listening, and observation of the family interaction, based on the holistic nursing assessment. After the assessment, I noticed that the patient had the problems of chronic pain, anticipatory grief, and the spiritual distress, etc. The nursing care plan for pain relieving was applied by medical therapy and complementary therapies. I encourage the patient to express his sorrow, feelings of loss and needs, and also encourage his family members to face the patient’s wish of going home. Through the creation of good nurse-patient relationship, therapeutic communication, actively listening, and accompany, the patient’s wish was fulfilled. I helped the patient to find the meaning of life through conversation, counseling, and life review gradually, and praised his effort and contribution to his family to identify his self-value. With the assistance of the social worker and the religious worker, the patient understood that death is a natural course. Finally, he could bravely face, accept, and prepare his own death and obtain peace of mind at the end of life. The report provided the nursing experience of biopsychosocial and spiritual care for a patient of hepatocellular carcinoma in terminal stage, which helped me to perform the holistic nursing assessment for terminal cancer patient in the future. Based on this experience, the nurses need to enrich the hospice related professional knowledge and abilities in order to maintain the quality of nursing care and obtain self-spiritual growth.