一位肺癌患者接受標靶治療不確定感之護理經驗

Nursing Experience with A Lung Cancer Patient Receiving Targeted Therapy Uncertainty

本文描述一位肺癌病患因多次化學藥物治療失敗，腫瘤無明顯緩解，改善首次接受標靶治療不確定感之照護經驗。護理期間為2010年10月14日至10月28日，運用Mishel疾病不確定感理論為架構，經由評估、觀察及會談完成行為過程紀錄，確立個案三項護理問題：（1）慢性疼痛／肺癌併肺外轉移及骨轉移有關；（2）肺癌及標靶治療的不確定感／肺癌嚴重性不明及初次使用標靶治療有關；（3）無望感／與多次化療後腫瘤無明顯縮小有關。護理過程中主動了解個案罹患癌症後身心靈多層面的問題，藉由按摩、放鬆技巧等措施緩解疼痛，運用Mishel不確定感量表評估並確立不確定感來源，藉由傾聽、陪伴建立護病間信任感改善無望感及接受標靶治療的不確定感，提供正確肺癌及治療相關知識，調適個案因不確定感所產生的心理壓力，主動說出內心焦慮且積極參與治療計畫，適當護理措施後個案表示經對標靶治療的深入了解，內心感到很踏實，重新找到生命的希望，並主動表示會珍惜接受治療的機會，繼續抱持希望，重新面對生活。

This article describes the nursing experience with a lung cancer patient who had failed multiple courses of chemotherapy and was receiving targeted treatment for the first time. Care occurred during the period from 14 to 28 October 2010 and the Mishel Uncertainty in Illness theory served as a framework Through assessment, observation and interviews, three areas of concern were identified: (1) chronic pain due to lung cancer and bone metastasis, (2) uncertainty about the course of cancer and the targeted therapy, (3) hopelessness because of multiple tumors and failed chemotherapy. Massage, relaxation techniques, and other measures were used to ease the pain. The Mishel Uncertainty Scale was utilized to establish the source of the uncertainty. Listening accompanied by the establishment of a nurse-patient relationship imparted a sense of trust which improved the sense of hopelessness and uncertainty about receiving targeted therapy. By addressing the inner anxiety, actively participating in treatment planning, and understanding targeted therapy, the patient was able to receive treatment and continue to hold out hope for the future.