提升糖尿病共同照護網照護率之改善方案

A Project to Improve the Patient Care Rate in a Diabetes Shared Care Network

本文敘述一位胰臟癌末期病人不想放棄治療，但是又覺得治療很痛苦，想放棄治療又不捨家人，對未來產生無望感及抉擇衝突的護理經驗。於2012年6月24日至7月7日照護期間，藉由身體評估、治療性會談、觀察等技巧，收集病人及家屬的相關資料，運用Gorden 11項健康功能評估，來呈現病人之身、心、社會及靈性狀況，發現健康問題有：一、疼痛／與腹部腫瘤壓迫神經反射至背部有關；二、無望感／與病情惡化無法控制有關；三、抉擇衝突／與是否接受安寧療護有關。筆者透過藥物治療、分散注意力、按摩、芳香療法等方法，減輕病人之疼痛；運用傾聽、陪伴及支持，讓病人和家屬彼此說出感謝和內心期望，以重建病人自我價值，了解生命正向意義；並藉由說明安寧醫療與治癒性醫療之不同處、安寧療護之意義及參觀安寧病房，使病人和家屬了解安寧療護之正確觀念，團隊和環境，進而接受安寧療護，以期病人和家屬在其生命最後一程能無遺憾又無痛苦的走完。藉此照護經驗能和其他護理同仁分享。

This article describes the care experience of a patient with pancreatic cancer at the terminal stage. He did not want to give up and leave his family, but the treatment was extremely painful. The future was filled with hopelessness and there were conflicts in decision making. Nursing care was provided from June 24 to July 7, 2012. Data were collected through physical assessment, interview, and observation. Gordon's 11 Functional Health Patterns Assessment guide was used to identify three health problems: pain and abdominal-tumor-related nerve compression with pain radiation to the back, hopelessness because disease progression could not be controlled, and decision conflicts over whether to accept hospice care. To address these problems, the author provided medication, distraction, massage, aromatherapy, and other methods to alleviate the patient's pain. Through listening, companionship, and support, the patient and his family expressed their expectations and gratitude to each other, thereby recovering the patient's self-worth, and positive attitude toward the meaning of life. By explaining the differences between hospice care and curative treatment and the meaning of hospice, and by arranging hospice ward visitation, the patient and his family clearly understood hospice care, the team, and the environment; hence, the patient was willing to receive hospice care. The patient can live the rest of his life without pain and regret. We report this valuable experience as a reference for practitioners in this field.