「意向與抉擇」一位鼻咽癌末期病人之照護經驗

Intention and Decision: Care Experience of a Patient with Late-Stage Nasopharyngeal Carcinoma

一位鼻咽癌末期個案預立醫療決策自主之護理經驗。照顧期間2020年1月19日至2月27日，運用Gordon十一項健康功能型態評估工具，經由觀察、會談、紀錄及身體評估等方式收集資料，進行整體性評估，發現個案問題有三項：潛在危險性感染、照顧者角色緊張與自由決策障礙等健康問題。教導案姐正確感染預防觀念及照護技巧，改善個案感染情形；藉由關懷與陪伴深入案姐內心，提供紓壓管道，降低案姐焦慮情緒；舉辦家庭會議給予醫療資訊，並運用安寧緩和照護理念引導，使個案能向案姐表達自己想法，掌握生命自主權。建議安寧共照團隊可盡早介入，提供個案與家屬心理調適與善終準備，鼓勵臨床護理師參與安寧療護與溝通輔導課程，培養正向態度與溝通技巧，提供個別性照護提升癌末個案照護品質。

This case report describes the care experience between January 19 and February 27, 2020 of a patient with late-stage nasopharyngeal carcinoma, which ultimately featured an advance directive. Data were collected using the Gordon's Eleven Functional Health Patterns assessment tool and through observations, interviews, records, and physical assessments for the comprehensive evaluation of the patient. The patient faced three major care issues: potential risk for infection, caregiver role strain, and barriers to free decision-making. To address these issues, three measures were adopted. First, the caregiver (the patient's elder sister) was educated on the principles of infection prevention and care techniques to reduce the risk of infection in the patient. Second, keeping the caregiver company and empathizing with her feelings provided a channel for the caregiver to relieve her stress, which contributed to the reduction of anxiety. Third, a family meeting was organized to provide the proper medical information to the family members of the patient. The concepts of hospice and palliative care were utilized to guide the patient in expressing his opinions to his caregiver and exercising his right of individual autonomy. The findings support early intervention by the joint palliative care team to assist patients and their family members in making mental adjustments and end-of-life preparations. Clinical nurses are also encouraged to participate in courses on hospice care and communication to nurture positive attitudes and communication skills, and provide individualized care to enhance the quality of care rendered to terminal cancer patients.