一位乳癌末期患者瀕臨死亡之照護經驗

The Nursing Experience of Caring a Patient with Late Stage of Breast Cancer

本文在探討一位乳癌末期病人身、心、靈至善終之照護經驗，照護期間自2012年6月5日至2012年6月21日止。筆者為外科病房護理人員，運用觀察、會談及身體評估等技巧收集資料及評估，發現個案有低效性呼吸型態、疼痛、無望感及家屬的預期性哀傷之護理問題。針對個案所出現之問題，給予個別性之護理措施，積極協助症狀之控制，有效減緩疼痛及呼吸窘迫情況。另外透過觀察、會談與傾聽，發現個案與家屬面臨死亡迫近的焦慮與哀傷，透過團隊的合作，協助個案與家屬互相表達情感，並鼓勵病患及家屬在有限的時間裡，相互傾訴對預期性哀傷的感受，交代後事的處置，給予身體、心理、靈性之全人照護，協助個案及家屬一起面對臨終的過程。照護期間筆者雖感受到病人的困境，卻無法運用良好溝通技巧引導病人說出心中的苦悶，最後與安寧共照師來一同協助溝通引導病人。因深感照護技巧顯不足，因此建議病房護理人員應多涉略有關心理諮商及溝通的技巧，提升自己對瀕死病人整體性照護能力，協助病人面對死亡。因在急性病房接受安寧共照個案越來越多，希望藉由此個案給予急性病房人員照顧上的經驗分享，落實安寧療護不設限於安寧病房之限制。

This article mainly discusses the nursing experience for taking care of a terminally breast cancer patient health, mind, and spirit to the hospice. During the nursing period from 5th June,2012 to 21 June 2012.The author of the surgical ward nurses use of observation, conversation and physical assessment skills to gather information and assess the cases. During the nursing process the author determined the primary nursing problems including ineffective breathing pattern ,pain, hopelessness and anxiety, anticipatory grieving, which is based on observing, talking, and listening for data collection and analysis. According to problems mentioned previously, the author provided individual nursing measures to help control symptoms effectively, reduce pain and respiratory distress situations. In addition, through observation, conversation and listening, found patients and families facing imminent death anxiety and grief, and cooperation through team to help patients and families express emotions and to encourage patients and their families in a limited time, talk to each other on anticipatory grief feelings, explain funeral disposal, giving the body, holistic mental, spiritual care, help the patient and family with the face of the dying process.I feel the plight of patients during care, because of a lack of good communication skills can not guide the patient tell the hearts of depression, according to the final and peaceful co-teacher to communicate with help guide patients. Who care deeply significant skills shortage, it is recommended that nurses should involve little more about the psychological consultative skills and communication, and enhance their ability to care for dying patients overall, to help patients facing death. Accept more and more cases of tranquility on acute care ward, hoping in this case given the experience of sharing acute care ward staff on the implementation of hospice is not limited to the restrictions set of hospices.