一位初次罹患肺癌併惡性肋膜積水面臨死亡恐懼之 案例報告

Nursing Experience of Caring for a Patient with Malignant Pleural Effusion Associated with Lung Cancer

本文探討一位初次罹患肺癌合併惡性肋膜積水面臨死亡恐懼之護理經驗,於2015/7/16 到 7/30 運用 Gordon 十一項健康功能型態,經由觀察、會談及身體評 估等方式蒐集資料,確立個案的護理問題有低效性呼吸型態、死亡恐懼及家庭因應能力失調。照護過程中,提供個別性的護理措施,包括藉由舒適擺位、精油穴位按 摩、使用電風扇吹拂個案臉龐,減輕呼吸喘的感覺;以同理心的態度建立治療性人際關係,給予宗教信仰及親情的支持,鼓勵參與各項醫療照護之決策過程,進而緩 解對於死亡的恐懼;以及多次安排家庭會議,建立有效溝通模式,增加彼此間共識,促進家庭因應能力,並與醫療團隊擬定共同的目標,以提升個案的生活品質及 正向面對疾病,經此照護經驗深刻了解家庭的支持及心靈安適是非常重要的,建議單位針對心靈層面,加強正確評估及處置能力,方能發揮護理獨特性功能,更提供 完整的方案使院方重視及積極建立安寧居家團隊,促進本院全人護理更加完善。

 

This article describes the nursing experience of caring for a patient with malignant pleural effusion associated with lung cancer, facing the fear of death from 16 to 30 July 2015. Based on observations, interviews, physical evaluation and Gordon’s 11 functional health patterns assessment, the author identified that the patient suffered from ineffective breathing pattern, fear of death and disabled family coping. During the nursing process, the author provided the patient with individualized nursing care including comfortable positioning, essential oil acupoint massage and applying draft of air to the face with fan to relieve short- ness of breath. To alleviate mental distress due to the fear of death, the author established a therapeutic nurse-patient relationship with empathic engagement, encouraged religious and family support, and motivated the process of shared clinical decision making. In order to enhance family coping, family meetings were conducted to establish effective communication and help achieve family consensus. In addition, the patient and family were encouraged to set up common goals with the medical team to improve the patient’s quality of life and positive thinking.This nursing experience demonstrated the importance of family support and good mental well-being for patients with cancer. It is recommended that the health care providers should emphasize nurses’ unique function of performing mental health assessment and intervention and provide comprehensive palliative care program to promote holistic nursing care in the medical settings.