照護一位肝癌末期病人之護理經驗

The Nursing Experience of Caring a Terminal Liver Cancer Patient

本文描述一位醫師告知只剩一個月存活期的肝癌末期個案，從接到噩耗到步向死亡之照護過程。護理期間自2018年4月30日至2018年6月1日，藉由觀察、會談、傾聽、身體評估以及病歷查閱進行資料收集，運用Gordon十一項健康功能型態評估，分析並歸納出個案有疼痛、無望感及預期性哀傷的健康問題。護理過程中主動關懷、傾聽及陪伴建立良好護病關係引導個案表達內心感受，藉由提供舒適擺位，教導使用音樂、芳香療法及按壓神門、心穴、皮質下和枕穴等方式改善病人疼痛問題；協同跨團隊人員與個案及家屬共同召開家庭會議，與家屬協商後決議告知個案病情，運用回憶治療與家庭支持，協助個案因應疾病變化增進自我價值，引導正向思考降低無望感受，完成人生四道習題，滿足心靈需求，幫助個案和家屬做好死亡準備，成就生死兩相安的圓滿結局，期望藉由此次的護理經驗提供護理人員日後臨床照護類似病人之參考。

This article described the experience of caring an end-stage liver cancer patient who was informed with one-month life expectancy by his physician. During the nursing period between April 30th, 2018 and June 1st, 2018, data were collected through observation, interviews, attentive listening, physical evaluations, and medical record reviews, using Gordon’s functional health pattern tool. Data were analyzed to conclude that the patient had pain, hopelessness, and anticipatory grief. The initiative was taken to provide the patient with active care with attentive listening to establish a healthy patient relationship. The patient was guided to express his inner feelings. In addition, the patient was offered comfort through repositioning, music therapy, aromatherapy, and acupressure. These all helped improve the patient’s pain. The staff collaborated with the patient and family to hold a family meeting to inform the state of illness. With the intervention and family support, the patient was assisted in coping with changes of life while reducing hopelessness, completing the four principles of life and fulfilling their heart and soul’s need. This helped the patient and family members properly prepare for the patient's death and find peace and calm in regards to life and death. It is hoped that this nursing care experience will provide a reference for future clinical care of similar patients.