運用舒適理論於一位肺癌病人善終之護理經驗

Nursing Experience with a Lung Cancer Patient Using Comfort Theory in Hospice Care

本文探討一位肺癌病人在放射治療後，合併多重器官轉移及衰竭，造成右肋膜積水及膿胸，使病人產生漸進性呼吸困難、食慾不佳導致身體更加虛弱的護理過程。過程中運用直接照護、陪伴、傾聽及穴位按摩的介入措施下，以Kolcaba舒適理論為架構，確立病人健康問題有：失效性呼吸型態、感染、跌倒危險性的健康問題，以穴位按壓的成效提供護理措施，適時掌握善終關鍵期。依病人個別性需求會診癌症及安寧個管師共同介入，以及精神共照護理師的引導病人深入會談，說出心中情緒困擾及對善終不了解導致的害怕，透過持續的關心，鼓勵病人表達內心感受，經由醫療團隊與家人溝通，尋求家人的支持，降低疾病造成身、心、靈的受苦，在生命末期選擇安寧緩和照護，提供全人醫療照護，使病人達到身心靈舒適狀態，面臨生命的終點不再恐懼，平靜有尊嚴地走完人生的旅程，希望藉此護理經驗分享，以做為臨床護理人員照護之參考。

This article describes the experience of a patient undergoing radiation therapy for multiple organ failure. Due to right pleural effusion, the patient had progressive dyspnea and anorexia. The author used direct care, observation, companionship, listening, and acupressure as interventions. Under Kolcaba comfort theory framework, it was found that the patient had the following health problems: breathing pattern failure, infection, risk of falls, inadequate nutrition, and emotional distress. The health team urged to seek family support in order to reduce disease causing the body, mind, and spirit suffer, especially during the final stage of life, and to choose hospice and palliative care, thus providing holistic health care.