照顧一位顱內惡性腫瘤術後行安寧療護之護理經驗

A Nursing Experience of Caring for a Hospice Patient Post-Craniotomy

本文探討一位因顱內惡性腫瘤術後導致呼吸器依賴行安寧療護息者之護理經驗。筆者於2013年3月1日至4月6日藉由觀察、照護、主動關懷與病人及家屬建立良好的治療性人際關係，並運用Gordon十一項功能性健康評估收集資料並確認以下問題，並給予個別性照護：1.自我照顧能力缺失(無法自行穿衣、沐浴、如廁、進食)/與神經肌肉障礙有關；2.呼吸器戒斷反應功能失常/與腦腫瘤有關；3.慢性疼痛/與腫瘤末期有關；4.死亡焦慮/害怕及疾病末期而導致死亡。隨著疾病之惡化，為讓個案能在生命最後歷程有良好的生活品質，病人及家屬決定選擇接受安寧療護，希望藉此個案之護理經驗，在呼吸照護病房工作的護理同仁日後照護類似個案時，能以安寧療護的觀點，秉持以病人為中心之理念協助病人。接受病人的選擇，陪伴他們走完人生最後一站。

This article describes a nursing experience of caring for a hospice patient with a malignant brain tumor. The patient had been ventilator-dependent post-craniotomy. During the nursing period from March1 to April 28, the author built a good therapeutic relation with the patient through patient observation, nursing care, and proactive caring. The author collected and analyzed the data with the Gordon's 11 functional health patterns tool. The identified nursing problems included a lack of ability of self-care due to neuromuscular disorder (the patient was unable to dress, bathe, use the toilet, and eat), lack of response to ventilator withdrawal due to brain tumor, chronic pain secondary to the end-stage brain tumor, and death anxiety/fear of the end stage of disease. As the patient's condition deteriorated, considering the patient's quality of life, the patient and family decided to choose hospice care. The author hopes that this report can be useful for other nurses taking care of patients in a similar situation. With an emphasis on patient-centered care, the nurses with hospice perspective may accept patients' decision and accompany them until the final stage of life.