協助一位膽管癌末期個案因應否認行為不當之護理經驗

Nursing Experience in Assisting an End-Stage Patient with Cholangiocarcinoma to Face Ineffective Denial

本文描述一位罹患膽管癌一年半接受過多次化學治療之個案，卻出現對疾病強烈否認態度之照護經驗，護理期間為2018年10月6日至11月3日，運用Gordon十一項功能性健康型態進行整體性評估分析，確立健康問題有：體溫過高、體液容積過量、否認行為不當。藉由讓個案保持舒適的身體溫度及運用薄荷油穴位按摩、腹部穿刺放液緩解個案生理不適；經由自製故事書並運用支持諮商及敘事療法等技巧，讓個案可以正視自身疾病，主動提及死亡議題，與家人互道歉、道愛、道謝、道別，並依個案意願親自簽立預立安寧緩和醫療維生醫療暨抉擇意願書，讓個案提早交待後事處理方式，完成心願。有鑑於此，建議落實宣導一般民眾醫療自主的重要性，尊重醫療自主權，在生命的最後能坦然面對生死。

This article described the nursing experience of caring for a patient with cholangiocarcinoma who has undergone chemotherapy for one and a half years, but has strongly denied attitude towards the disease. The nursing period was from October 6 to November 3, 2018, by using Gordon's Functional Health Patterns as a guide to conduct a holistic assessment. The problems identified were hyperthermia, fluid volume excess, and ineffective denial. Discomforts were relieved by keeping the patient's body temperature comfortable, using mint oil acupressure, applying abdominal puncture, and placing drainage. Self-made storybook and use of communication skills such as support counseling and narrative therapy, etc. were provided, so that the patient can face her illnesses, actively mention issues of death, and told their families Lessons from the Dying: apologize, love, thank, goodbye with each other and personally sign a pre-medical decision (Do not resuscitate, DNR). It also allowed the patient to prepare for her own funeral in advance. In view of this, it is recommended to emphasize the importance of medical autonomy to the public, respect medical autonomy, and be able to face death at the end of life.