照顧一位有自殺意念口腔癌復發個案之居家護理經驗

Home Care Experience for a Case of Oral Cancer Recurrence with Suicidal Ideation

本文探討一位口腔癌復發個案，因疼痛及無望感而萌生自殺意念的照護經驗。照護期間2021年9月8日至10月28日，筆者藉由持續性電訪、家訪及回診時面對面的服務，與個案建立良好護病關係，運用觀察、深度會談、身體評估等方式收集資料，綜合生理、心理、社會及靈性層面進行整體性評估，確認個案主要健康問題有:疼痛、癌因性疲憊、無望感。筆者運用芳療按摩、正念呼吸、音樂療法緩解疼痛，漸進式運動及穴位按壓緩解癌因性疲憊；同理傾聽個案悲傷歷程，運用全家福照片進行生命回顧，協助轉化成正向經驗，肯定生命歷程，帶領禱告，使個案重建信心，消除自殺意念。建議未來照護頭頸癌復發個案，患者常會面臨身心煎熬，可能出現焦慮、憂鬱、恐懼、絕望等情緒困擾，甚至有自殺意念。因此，照護過程中，應定期評估患者的情緒狀態，並給予適當的介入，儘早透過跨領域團隊合作照護，結合社區資源整合、促進患者康復，期待藉此經驗，可做為日後照顧之參考。

This article primarily explores the caregiving experience of a recurrent oral cancer patient who developed suicidal ideation due to pain and a sense of hopelessness. During the nursing period, from September 8, 2021 to October 28, 2021, author establish a good care relationship with the patient through continuous telephone interviews, home visits, and face-to-face services during follow-up. To collect data through observation, in-depth interviews, and physical assessments. Conduct a holistic assessment integrating physiological, psychological, social, and spiritual dimensions. The main health issues confirmed in this case included: pain, cancer-related fatigue, hopelessness. The author used aromatherapy massage, mindful breathing, and music therapy to alleviate pain, as well as progressive exercise and acupressure to relieve cancer-related fatigue. Accompanying and empathetically listening to the case's grief process, using family photos for life review, transforming past experiences into positive experiences, affirming the meaning of life, leading prayers, so that the case can rebuild confidence and eliminate suicidal thoughts. For future care of head and neck cancer recurrence cases, patients often face physical and mental anguish, which may result in anxiety, depression, fear, and despair, and even suicidal thoughts. Therefore, during the care process, it is essential to regularly assess the patient's emotional state and provide appropriate interventions. Early multidisciplinary team cooperation and integration of community resources should be implemented to promote patient recovery. This experience is expected to serve as a reference for future care.