照護一位乳癌末期併多處轉移個案接受安寧療護之護理經驗

Nursing Experience for A Patient with Terminal Breast Cancer and Multiple Metastases Who Received Hospice Care

本文探討一位乳癌末期併多處轉移個案，因病況惡化故醫師建議接受安寧緩和療護之照護經驗。照護期間自2021年9月27日至10月4日，藉由觀察、會談、臨床照護及病歷查閱等方式蒐集資料，評估個案之生理、心理、社會及靈性四大層面，發現個案有低效性呼吸型態、疼痛、預期性哀傷及決策衝突等健康問題。透過給予合適之氧氣療法、指導噘嘴式呼吸、使用手持式風扇等提升其氧合及改善呼吸淺快情形，與醫療團隊討論調整常規止痛藥物並鼓勵透過音樂及舒適臥位等非藥物措施緩解疼痛，予同理傾聽引導情緒抒發，鼓勵個案與家屬互相表露哀傷情緒、正向面對死亡並藉完成心願以減少遺憾，主動澄清個案對安寧療護之錯誤認知並協助轉介安寧緩和團隊，提供完整醫療資訊使個案確立抉擇，最終接受安寧療護，提升餘生生活品質。因風俗民情避談死亡及對安寧療護之既定概念易使國人對接受安寧療護產生排斥，導致無效醫療之產生，故建議政府可藉由國民基本教育及多媒體普及化安寧相關資訊，並結合長照等服務增加可近性，醫護人員也應主動學習相關課程以提升自我之臨終照護品質。

This article explores the case of a patient with advanced-stage breast cancer and multiple metastases, whose condition worsened, leading the physician to recommend palliative care. The nursing period was from September 27, 2021, to October 4. Data were collected through observation, interviews, clinical care, and medical record reviews. Evaluated the case through four major dimensions: physical, psychological, social and spiritual. Health issues identified included ineffective breathing pattern, pain, anticipatory grief, and decisional conflict. Improve oxygenation and shallow breathing by giving appropriate oxygen therapy, guiding pursed-mouth breathing, and using hand-held fans. Pain management was adjusted in consultation with the medical team, with encouragement for the use of non-pharmacological methods such as music therapy and comfortable positioning to ease pain. Listen with empathy and guide emotional expression, encourage patients and family members to express their grief to each other, face death positively, and reduce regrets by fulfilling wishes. Actively clarify the patient's misconceptions about palliative care and assist in referral to the palliative care team, provide complete medical information to enable the patient to make a decision. Ultimately, the patient accepted palliative care, which improved the quality of their remainder life. Due to cultural customs and the tendency to avoid discussing death, many people may resist accepting palliative care. Therefore, it is recommended that the government promote palliative care information through basic education and multimedia, and integrate it with long-term care services to increase accessibility. Healthcare professionals should also proactively engage in related training to enhance the quality of end-of-life care.