運用品質關懷模式照顧一位末期子宮頸癌年輕婦女之護理經驗

Applying the Quality Caring Model in a Nursing Experience for A Young Woman with Terminal Cervical Cancer

末期子宮頸癌常因腫瘤浸潤、壓迫，導致淋巴水腫及疼痛，隨著癌細胞轉移及侵犯，將出現失落與哀傷等情緒反應，特別是年輕婦女，當癌症已達末期階段，擔心死亡的到來，又無法陪伴小孩成長，將使其產生極大的愧疚。本文探討一位末期子宮頸癌年輕婦女之護理經驗，照顧期間自2019 年7 月9 日至8 月1 日，筆者以觀察、會談、身體評估及病歷查閱等方式收集資料，並運用Gordon 十一項功能性健康型態評估，確認個案主要之健康問題有：慢性疼痛、組織完整性受損及預期性哀傷。照護過程運用Duffy 品質關懷模式，藉「歸屬感需求」、「人類基本需求」、「療癒環境」及「共同解決問題」等品質關懷要素，提供主動關懷、疼痛處置及身體清潔，維持個案舒適及傷口周圍皮膚乾燥、無異味；透過跨領域醫療團隊合作，提供個案與家人獨處空間，引導彼此表達「道愛、道謝、道歉、道別」四道人生，在臨終前完成心願、走過哀傷。期望此護理經驗能提供日後照顧類似個案參考。

"End-stage cervical cancer often causes lymphedema and pain due to tumor infiltration and compression. When faced with cancer cells metastasis and invasion, patients react emotionally, experiencing a sense of loss and grief, and this phenomenon is especially pronounced in young women. A patient in the terminal stage of cancer worries about the coming of death and might feel very guilty about not being able to accompany her child as he or she grow ups. The purpose of this article was to explore an experience of providing nursing care to a young female patient with end- stage cervical cancer. The nursing period was from July 9 to August 1, 2019. Gordon’s 11 functional health patterns assessment was used as a tool for the nursing assessment. The relevant data were collected through observations, interviews, physical assessments, and reviews of medical records. The major health problems identified included chronic pain, impaired tissue integrity, and anticipatory grief. Applying Duffy’s Quality-Caring Model, quality care elements such as “affiliation needs,” “basic human needs,” “healing environment,” and “mutual problem solving” were integrated into the caregiving process. We provided active care, pain management, and hygiene management to maintain the patient’s comfort, as well as to ensure that the skin around her wound was dry and odorless. Through a cross-disciplinary health care team collaboration, we provided the patient and her family members with a private space where they could express their feelings about the four principles of life (love, gratitude, forgiveness, and grace in bidding farewell), so as to fulfill the patient's wishes and allow her to come to terms with her grief before dying. This nursing care experience can serve as a reference for health care professionals who provide care to young women with end-stage cervical cancer."