一位胃癌末期老人生命回顧之安寧療護經驗

The Hospice Care Experience for Life Review in an Elderly Patient with Terminal Gastric Cancer

本文旨在運用Swanson關懷理論協助一位接受安寧療護之胃癌末期老年病人進行生命回顧之經驗，個案於2019年確診胃癌合併骨轉移，此次因呼吸困難入院，住院期間因疾病進展及面對疾病的不確定性，衝擊其心靈，進而影響生活品質，故引發筆者探討動機。照護期間自2020年4月8日至2020年4月16日，運用全人照護之生理、心理、社會、靈性四層面進行評估，藉由與個案及家屬會談、病歷查閱等方式收集資料，確立健康問題為舒適障礙、口腔黏膜受損、心靈困擾。護理期間運用Swanson關懷理論及安寧療護理念，以傾聽來了解個案及家屬想法及感受，並在旁陪伴，提供安靜且放鬆的環境、放鬆技巧、疼痛控制、口腔護理等措施，並適時評估措施執行成效，緩解個案不適症狀及感受，另引導個案進行生命回顧，重整及肯定其生命意義與價值，以維持信念。透過個別性照護措施，讓個案學會放下與珍惜，降低個案心靈困擾，最終得以善終。期望藉此個案護理經驗與臨床護理人員分享，提供未來照護此類個案之參考。

The paper described the experience of using Swanson’s theory of caring for life review in an elderly terminal gastric cancer patient receiving hospice care. The patient was diagnosed with gastric cancer with bone metastasis in 2019, and was admitted due to dyspnea. During hospitalization, disease progression and disease uncertainty impacted her emotionally, which affected her quality of life. During the care period from April 8th to 16th, 2020; the 4 aspects of holistic care including physiological, mental, social, spiritual domains were used for evaluation. Data was collected through interviews with the patient and family members, and by examining her medical records. Her health problems were determined to be impaired comfort, impaired oral mucous membrane, and spiritual distress. During the care period, Swanson’s theory of caring and the concept of hospice care, were used to observe the thoughts and feelings of the patient and family members. Companionship was also provided, along with a quiet and relaxing environment, relaxation techniques, pain control, oral care and other measures, health education on care techniques was carried out, and an assessment was conducted. In addition, the patient was guided to carry out life review, reorganize, and affirm his/her meaning of life and value, for maintaining belief. Personalized care measures were employed for the patient to learn to let go and accept, as this decreased mental distress, enabling her to pass away peacefully. We hope that this nursing experience can be shared with clinical nurses as a reference for future care.