一位扁桃腺癌末患者瀕臨死亡之護理經驗

Nursing Experience of Terminal Care for a Patient with End-Stage Tonsillar Cancer

本篇探討一位39歲男性扁桃腺癌病人，因癌症復發進展至惡化，醫療團隊無法再積極治療，面臨死亡威脅及心理衝擊，反應出焦慮。自2012年6月5日至7月5日照護期間，個案因癌症轉移導致身體疼痛不適、吞嚥困難及食慾不振導致營養不良，歸納出護理問題：慢性疼痛/與癌細胞轉移壓迫所致、營養狀況改變/少於身體所需、死亡焦慮/與癌症末期瀕死有關。筆者於護理過程中，應用安寧共照模式，主動關懷、同理心與接受等方式，提供病人身、心、靈整體照顧，提供照顧技巧。照顧過程中關注個案與家屬情緒反應，鼓勵說出其心中感受，進而接納死亡事實。

A 39-year-old man suffered from tonsillar cancer with recurrence and progression, and the medical team could not give further active treatment. The patient faced death threats and psychological impact reflecting his anxiety. During the nursing period from Jun. 5, 2012 to Jul.5, 2012, we found the patient had physical pain and discomfort, difficulty swallowing, and loss of appetite leading to malnutrition due to cancer metastasis. Hence, the following nursing problems were summarized: Chronic pain-due to metastatic cancer cell compression; Nutritional status change less than the body required; and End-stage cancer-related death anxiety. The author applied concept of palliative hospice, active care, empathy and acceptance of other ways to provide care for the patient with body and soul as a whole. In the care process, we were concerned with the emotional reaction of the patient and family, encouraged the patient to speak his heartfelt feelings, and then accept the fact of death.