陪伴一位睪丸癌末期青年及家屬經歷臨終之護理經驗

The Nursing Experience of Caring for a Terminal Young Adult Cancer Patient and Family Facing End-of-Life

本文旨在應用安寧療護理念，協助一位罹患睪丸癌末期青年及其家屬因應死亡衝擊之照護經驗。照護期間為2019年4月27日至5月16日，運用Gordon十一項健康功能評估，藉由治療性會談、觀察等技巧，確認影響個案身心舒適甚鉅之「疼痛」、「死亡焦慮」及家屬所面臨之「哀傷」為主要健康問題。藉由與醫師討論調整止痛藥物、精油按摩及舒適姿勢擺位緩解個案疼痛不適；引導個案說出面對死亡的感受，及安寧團隊介入，並運用生命回顧及四道人生引導臨終道別，降低個案面對死亡的焦慮；以溫和的態度引導家屬說出面對個案死亡的想法、運用同理心接納家屬悲傷情緒，並鼓勵實際參與臨終照護，為個案後事做準備，陪伴個案走過人生最後的旅程，以抒發哀傷情緒。希望藉此護理經驗，提供未來臨床照護瀕死癌末青年之參考，以提升臨終照護品質。

This paper is about a nursing experience with applying hospice palliative care. By assisting a young patient of testicular cancer and his family in facing with the shock of death. The period of care is from April 27 to May 16, 2019. By using Gordon's 11 health function assessments, healing talks and observation techniques. We confirmed that the main nursing problems are“pain”,“death anxiety”, and the“grief”which the family have faced. During the care process, we discussed with the doctor to adjust pain medication, and using essential oil massage and comfortable posture to relieve the pain and discomfort of the patient; For the patient, we guided him to express his inner feelings about the death; cooperated with the hospice nurse, using life review and four themes of life guides to say goodbye to each other for decreasing his anxiety about death; For the family members, we guided them with a gentle attitude to express their feeling about facing the death of the patient, to accept the family’s grief with empathy. We also encouraged them actual participation in end-of-life care, preparing for the funeral of the patient, accompanying the patient through the last journey of life and vented their grief. It is hoped that this nursing experience can provide a reference for future clinical care of terminal young adult cancer patient who is facing death to improve the quality of end-of-life care.