照顧一位膀胱癌末期面臨死亡焦慮之透析病人照護經驗

Care Experience for A Dialysis Patient with Death Anxiety at Terminal Stage of Bladder Cancer

本篇在探討一位膀胱癌末期透析病人，因癌末帶來身心不適的症狀，面對死亡將至而產生的焦慮，而家屬面臨倫理抉擇困境之照護經驗。護理期間自2015 年1 月8日至2015 年1 月28 日，筆者運用羅氏適應模式評估，藉由直接照護、會談、觀察家庭互動、病歷及身體評估等方式收集資料，分析慢性疼痛、營養狀況改變，少於身體需要、死亡焦慮、抉擇衝突等護理問題。 護理過程中，運用舒適擺位、精油按摩及音樂治療緩解疼痛感；澄清飲食注意事項及擬定營養計畫改善食慾不振等措施。運用同感心陪伴傾聽、鼓勵表達內心感受面對死亡過程，克服死亡焦慮及哀傷，提供相關醫療資訊，以病人利益為考量，面對病情變化造成的抉擇衝突，提供舒適與尊嚴，達到善終的目的。

 

This article explores the nursing care experience for a dialysis patient at terminal stage of bladder cancer, the symptoms of physical and mental discomfort, the anxiety caused by the prospect of death and the ethical choices the family has to face. During the care period from January 8, 2015 to January 28, 2015, the author used the Roche adaptation model to analyze issues including chronic pain, nutritional status, less than physical needs, death anxiety and choice conflicts regarding care. Data collection was done through direct care, interviews, observation of family interactions, medical records and physical assessment. During the care process, comfortable position, essential oil massage and music therapy can be used to relieve pain; clarification of dietary precautions and formulation of nutrition plans are measures that can help improve appetite. Be an empathetic listener, encourage patients to express their inner feelings about facing the process of dying to overcome anxiety and grief. Keep in mind patient’s best interest, provide relevant medical information when they face choice conflicts over condition changes, maintaining comfort and dignity until the end.