協助一位肺癌末期病人善終之護理經驗

End-of-life care Experience of a Patient with Terminal lung Cancer

本文為敘述一位肺癌末期個案面臨病情急遽惡化所帶來的身體不適及面臨死亡的威脅下，心中仍牽掛與家人的點點滴滴，照護期間自2022年3月18日至4月15日，藉由身體評估、觀察、病歷查閱、會談等方式收集資料，運用生理、心理、社會與靈性進行整體性健康評估，發現個案有呼吸道清除功能失效、慢性疼痛及哀傷等護理問題。護理過程提供直接臨床照護以疼痛緩解增加舒適為主，並結合安寧醫護團隊協助，透過有計畫的善終關懷護理措施，於每次會客探視個案時間，給予家屬充分時間陪伴個案，並傾聽家屬訴說內心感受，逐漸建立家屬對醫護的信任感，引導個案與家屬表達出對彼此內心感受與道別，安詳走完人生旅程。照護癌末病人及其家屬對護理人員是一大挑戰，當面對醫療極限疾病仍無法治癒時，安寧緩和療護能提供個案善終與家屬無憾之全人照護，期望藉此個案報告經驗，作為往後照護此類個案的參考。

We describe the case of a patient with terminal lung cancer who experienced physical discomfort due to rapid disease progression and imminent death, along with distress due to their desire to spend every moment with family members. The nursing period spanned from March 18, 2022 to April 15, 2022. Data were collected through physical assessments, observations, reviews of medical records, and personal interviews. A holistic health assessment incorporating physiological, psychological, social, and spiritual dimensions was conducted. Nursing care issues identified through this approach included ineffective airway clearance, chronic pain, and grief. The nursing care process included direct clinical care focused on pain relief and increased comfort in conjunction with planned end-of-life care provided by hospice personnel. This approach provided the patient’s family members to spend sufficient time with the patient during each visit and allowed them share their feelings with hospice personnel and build trust. Hospice personnel also guided the patient and family members in expressing their feelings toward one other and saying goodbye, thereby helping them achieve a sense of closure. Caring for patients with terminal cancer and their families is a major challenge for nursing personnel. The aim of this case report is to provide a reference for similar future cases and to help develop a holistic approach to hospice and palliative care that alleviates regrets for patients and their family members facing incurable disease.