一位大腸癌末期病患併發放射性出血性膀胱炎之護理經驗

Applying Discharge Plan for a Patient of Terminal Stage Colon Cancer With Continuing Bladder Irrigation

本文敘述一位合併肝、肺轉移的大腸癌個案，於癌症末期併發放射性出血性膀胱炎，行連續性膀胱灌洗，以預防血塊阻塞泌尿道之護理經驗。因缺乏照護能力，使個案害怕無法出院返家與家人相聚，及完成壽終正寢的心願，住院期間不僅對自我失望，引發身心不適，也因拒絕手術治療及轉介地區醫院慢性病房，造成了醫、病、家屬間的緊張和不安。筆者於照護期間，除了擔任三方溝通橋樑，也帶領個案和家屬認識安寧療護，護理過程中運用羅式護理適應模式，評估個案與家屬的護理問題和出院準備需求，提供護理措施達到良好的症狀控制，並擬定照護計劃，指導連續性膀胱沖洗系統的居家照護，及協詢居家醫療照護資源，除了提升自我照護能力，也解除彼此間的疑慮和緊張關係，順利完成個案及家屬出院返家的心願，接受居家安寧照護，獲得身、心、靈的滿足。

For a cancer patient in the terminal stage, it is not only meaningful for him to be accompanied by his family in an intimate environment, but also th have his rights. This article is about a patient who had colon cancer, with metastasis to liver and lung, had experienced surgical, chemical, and radical therapies. He had reaction hemorrhagic cystitis in the last period of his life, and should be treated by placing three-way urinary catheter for normal saline continuous irrigation in urinary bladder to prevent blood clot obstructing uretheral tract. In this case, the patient could not get discharged from the hospital nor could he go back home to be with his family to fulfill his wish of having his life ending peacefully. This caused the patient to be disappointed and to experience related physical-mental discomfort. There was also tension and discomfort among the patient his family and medical staff because of the patient's refusal to treatment or transfer to an other hospital. The author became the bridge of communication among the patient, his family and medical staff during her nursing care period. She resolved the tension between one another and helped the patient and his family to receive hospice care. In the process of providing discharge service, The author used Roy Nursing Adaptation model to evaluate the patient and his family's need to prepare for discharge, and set up discharge plan together with the patient and his family. In addition to asset the patient to control his symptoms, the author also instructed them home care procedure of using continuous urinary bladder irrigation system, and helped the patient get home-care medical resources. Finally, the patient and his family's wish was fulfilled, and the patient was discharged from the hospital receiving hospice care at home, with physical, mental, and spiritual satisfaction. The nursing care process really achieved the 4-whole theory of hospice care: whole man, whole family, whole process, and whole team care.