運用品質關懷模式照顧一位末期結腸癌患者之護理經驗

Applying the Quality Caring Model in a Nursing Experience for a Patient with End-stage Colon Cancer

惡性腫瘤已連續39年排名台灣十大死因第一位，其中結腸直腸癌蟬聯所有癌症死亡原因第三名，且死亡率逐年攀升。本文探討一位末期結腸癌患者之護理經驗，照護期間自2020年7月30日至9月17日，筆者以觀察、會談、身體評估及病歷查閱等收集資料，並運用Gordon十一項功能性健康型態評估，確立個案有慢性疼痛、低效性呼吸型態及無望感之健康問題。照護過程運用Duffy品質關懷模式，藉「人類基本需求」、「鼓勵的方式」、「共同解決問題」、「尊重」及「療癒的環境」等品質關懷要素，提供主動關懷陪伴、教導舒適擺位、穴位按摩及用小電風扇朝臉部輕吹，緩解個案疼痛及呼吸困難感受；以安寧照護理念，引導個案說出對死亡的感受並透過遠距家庭會議與案妻及案子「道愛、道謝、道歉、道別」，在臨終前完成心願安詳離世。建議未來可將哀傷輔導納入護理人員在職訓練，並安排社工師及安寧共照師分享跨領域實務經驗，以提升護理人員臨終悲傷輔導技能、增進末期結腸癌患者之照護品質。

Malignant tumors have ranked first among the top ten major causes of death in Taiwan for 39 consecutive years. Among them, colorectal cancer is the third cause of death from all cancers, and the mortality rate is increasing year by year. The purpose of this article was to explore a nursing experience of caring for an end-stage colon cancer patient. The nursing period was from Jul. 30 to Sep. 17, 2020. Gordon’s 11 functional health patterns assessment was used as a tool for nursing assessment. The data were collected through observation, interview, physical assessment, and medical records. The major health problems identified included chronic pain, inefficient breathing pattern, and hopelessness. By applying Duffy’s quality caring model, quality care elements such as “basic human needs”, “encouraging manner”, “mutual problem solving”, “human respect”, and “healing environment” were used during the caregiving process. To relieve pain and dyspnea of the patient, we provided active caring companionship, taught him comfortable positioning techniques and acupressure, and blew gentle wind over his face with a small fan. Through palliative care concepts, we led the patient to express his feelings and convey “love, gratitude, apology, and farewell” to his wife and son by video calls, to fulfill the patient’s wishes before dying and pass away peacefully. It is suggested that in the future, grief counseling can be incorporated into the on-the-job training of nurses, and social workers and palliative caregivers should be arranged to share cross-disciplinary practical experiences, so as to improve the end-of-life grief counseling techniques of nurses and the quality of care for patients with end-stage colon cancer.