運用陪伴概念於一位肺癌腦轉移受苦個案之照護經驗 - 護理本質之反思

The Caring Experience of Using The Concept of Presence on A Lung Cancer Patient with Brain Metastases: The Reflection of Nursing Nature

本文在描述運用陪伴概念於一位肺癌腦轉移受苦個案之照護經驗，並透過照護過程反思護理本質的內涵。護理期間2014年10月17日至2014年11月26日，運用病歷查閱、同理性溝通與觀察技巧進行資料蒐集，輔助受苦量表進行受苦程度評估，察覺個案受苦於身體功能改變、擔憂成為他人負擔及對信仰產生存疑等身體、心理及靈性受苦等三個主要護理面向問題，筆者以陪伴概念作為介入措施，照護過程運用傾聽、同理、親密感建立信任治療性關係，讓病人感受照顧者對他的專一，願意分享感受，進而找出個案症狀控制的方法，適應疾病造成的生活改變，並且具正向面對疾病衝擊的態度，重新找出生命存在價值意義，減緩身體、心理及靈性的受苦經驗，期望本文相關經驗可提供臨床護理人員照護相同個案的參考，透過陪伴過程的接觸與觀察，協助病人與家屬疾病的適應，使護理過程更具人性化。

The article was for nursing experience of using the concept of presence on a suffering lung cancer patient with brain metastases. We reflected the nursing nature through the caring process. The period of nursing care was from October 17 to November 26, 2014. We used the medical records reviewing, empathic communication, and observation skill to collect data and used the Suffering Scale to assess the suffering level. We perceived the patient had physical, psychological, and spiritual nursing problems. The patient suffered from physical function changes, disappointed at the disease and physical function changes, worried to be on somebody’s back, and had doubt about faith. We regarded the concept of presence as intervention, and using the listening, empathy, and intimacy to build the trust therapeutic interpersonal relationship during the caring process. Let the patient feel he was regarded, and willing to share his feeling. We had found the methods to control the patient’s symptom, helped the patient to adapt the disease to the new life, and had positive attitude toward the disease’s impact. We had made a fresh start to find the value of existence in the life to reduce the physical, psychological, and spiritual suffering experiences. We hope this experience can let the nurse know how to contact and observe patients through the concept of presence and assist the patients’ and families’ adaption of disease, and be more humanitarian in the nursing process.