照護一位大腸癌末期病人面臨醫療決策衝突之護理經驗

The Nursing Experience of a Terminal Colorectal Cancer Patient to Face a Decisional Conflict

本文描述一位大腸癌末期個案因病程惡化快速，以致面臨生理折磨及死亡威脅，過程中家屬難以接受病人病況與不同的壓力下，以致病人與家人間對於後續醫療決策不斷地徘徊而產生衝突之護理經驗。照護期間自2021年01月03日至02月05日，運用生理、心理、社會及靈性四大層面架構作為評估工具，藉由觀察、傾聽、身體評估及查閱病歷等方式收集資料，確立個案有慢性疼痛、營養少於身體所需、抉擇衝突及無望感等健康問題。照護期間提供藥物及非藥物之個別性技巧緩解疼痛不適；給予靜脈營養支持維持身體機能；藉由安寧緩和團隊向家屬澄清安寧緩和醫療迷思，並召開家庭會議引導雙向溝通，協助化解家庭衝突；後續運用生命回顧及緬懷過往方式，使個案肯定自我價值，最終達成家庭醫療間共識及個案內心期望。希望藉此照護經驗分享，做為未來照護此類個案之參考。

This paper describes the nursing experience of a patient of terminal colorectal cancer who faced the physical torment and the threat of death when the individual’s condition deteriorated in the course of the disease, that during which the family members were stressed and reluctant to accept the situation, as shown by their conflict and hesitation in the follow-up medical decision-making. During the care of patient from January 3 to February 5 of 2021, the four major aspects of physiology, psychology, society and spirituality were the dimensions of assessment and data were collected through observation, listening, physical evaluation and medical record to establish that the patient was suffering from health issues such as chronic pain, malnutrition, conflict of choice and a sense of hopelessness. In this period, both drug and non-drug treatments, such as pain-relieving technique, were given, along with intravenous nutrition supplement, to maintain bodily functions. The family members’doubt about palliative medicine was clarified by the support team, where a family meeting was organized to guide two-way dialog to resolve family conflict. Later, by remembering through the patient’s life and the past, the patient was reasserted with self-worthiness that an agreement between the family and the medical staff was reached in accordance with the patient’s expectation. It is hoped that this nursing experience will be shared with colleagues in the field and serves as a reference for future care of similar cases.