協助一位胃癌末期合併肝轉移病人善終之護理經驗

Nursing Experience of a Patient With Terminal Gastric Cancer and Liver Metastasis Who Received Hospice Care

本文描述一位胃癌合併肝轉移末期病人面臨呼吸喘、腹脹等不適，期待能參與兒子婚禮的護理經驗。照護期間為2013年4月24日至5月13日，運用Gordon十一項健康功能評估為工具，藉由身體評估、理學檢查、觀察、會談等方式收集資料，確立個案有「低效性呼吸型態」、「舒適情況改變」、「焦慮」、「預期性哀傷」等護理問題。筆者運用傾聽、同理、陪伴、關懷方式，建立治療性人際關係，配合醫療處置提供個別性護理措施，如：提供氧氣、指導翻身擺位技巧、床旁小風扇使用減緩呼吸喘不適；準備個案喜愛食物、少量多餐，進食以滿足口慾為主，家屬能尊重個案感受，不勉強進食；使用茶葉水提供口腔護理，促進舒適；召開家庭會議說明個案心願，克服困難，在團隊合作下，協助案子完成婚禮，完成個案心願，讓個案及家屬均平安，希望藉由此照顧經驗分享，提供護理人員照護臨終末期病人的參考。

This article details a nursing experience regarding a patient with terminal gastric cancer and liver metastasis who experienced side effects such as dyspnea, abdominal distension, nausea, and vomiting. To verify the patient's health problems, such as inefficient breathing patterns, changes to comfortable circumstances, anxiety, and anticipatory grief, we collected data by performing a physical assessment and examination, observing the patient, and conducting an interview by using Gordon's 11-item functional health patterns during his hospitalization from April 24, 2013, to May 13, 2013. We used various strategies, including showing empathy, providing companionship, and personalizing care, to establish a therapeutic relationship with the patient. Moreover, the following medical treatments were provided: guidance for positioning skills, slow breathing at the bedside by using a small fan, preparing favorite foods, serving smaller meals, overcoming diffi culties and cooperation in team through family meetings, and helping the patient realize his wish to attend his son's wedding. We're wondering to share our experience by providing nursing care for the terminal patient.