協助肺癌末期病人在宅善終之護理經驗

Nursing Experience of Helping a Patient Having Good Death at Home during the Terminal Phase of Lung Cancer

本文描述協助一位肺癌末期病人在宅善終的護理經驗。護理期間為2019年12月23日至12月26日，藉由溝通、觀察、會談、身體評估方式，做病人身體、心理、社會及靈性層面評估，確認病人有低效性呼吸型態、疼痛及焦慮無法在宅善終等健康問題。護理過程中協助採半坐臥式，於其胸前放置枕頭，讓胸廓擴張以利舒適呼吸；使用無香料的凡士林乳液，按摩肩、頸及臀部，按時給予適量止痛劑，以減低疼痛不適；針對個案病情變化及後續治療進行說明，讓病人及家屬了解安寧緩和條例，釐清病人對死亡的想法，讓家屬及病人共同面對瀕死；提供心理支持並轉介安寧居家護理師，教導家屬舒適照護技巧，使後續照顧自醫院延伸到居家，滿足病人身、心、靈需求，完成病人在宅善終心願。病人於出院後三天，在家人陪伴下安逝。此在宅善終護理經驗的分享，可做為協助癌末病人返家計畫之參酌。

This case report described nursing experience of helping a patient have good death at home during the terminal phase of lung cancer. The nursing period was from December 23 to 26, 2019. Through communication, observation, interview, and physical assessment, we collected data on physical, psychological, social, and spiritual aspects of this patient. The nursing problems included low effectiveness of breathing pattern, pain, and anxiety of not being able to have good death at home. During the nursing period, semi-recumbent position and pillow support were arranged to facilitate the chest expansion and comfortable breathing. Vaseline cream was used to massage the shoulder, neck, and buttocks, combining with analgesics to relieve pain. Changes of patient’s condition and the follow-up treatment were explained to the patient and family members so that they can understand the Hospice Palliative Care Act and the conception of death, confronting death together. The family members agreed upon good death at home and expressed their grieving feelings. In addition, home hospice care was provided to teach family members the comforting skills and continuing care. Integrated care was extended from hospital to home which satisfied the patient’s physical, psychosocial, and spiritual needs, and fulfilled his wish to have a good death at home. Three days after being discharged from the hospital, the patient passed away at home, accompanied by family members. The nursing experience could serve as a reference for nurses caring for patients having good death at home during the end of life.