運用安寧療護理念於肝癌末期病人之護理經驗

The Concept of Hospice Care for a Terminally Ill Liver Cancer Patient: A Nursing Experience

本文是探討一位54歲男性，於2012年1月診斷為肝癌，至同年9月期間因腸胃道出血狀況反覆（包括解黑便及吐血）入院，後期協助善終之護理經驗。筆者2012年10月15日至11月16日照護期間，個案歷經住院、居家安寧照護、住院安寧共同照護，最後回歸安寧病房善終，依據與個案直接照護、會談、觀察及病歷查閱等方式做資料收集，以生理、心理、社會及靈性層面進行整體性之護理評估，顯示個案有疼痛問題∕癌症腫瘤及骨轉移影響、案妻預期性哀傷∕與個案病情變化臨終有關和靈性困擾∕面臨死亡導致對疾病控制的無望感三個護理問題。筆者依安寧療護理念為基礎，運用舒適護理與疼痛控制，緩解個案身體不適；利用陪伴溝通技巧方式，協助個案靈性困擾；以悲傷輔導觀念，陪伴案妻面對失落哀傷過程，使其以個案及家屬為中心，提供完整性照護；透過醫療團隊成員提供全人、全家、全隊、全程之照護，最後在家屬陪伴之下完成個案後事安排，達到生死兩相安的使命。期望藉此珍貴的護理經驗，運用於臨床照護實務中，作為專業團隊對於末期病人及其主要照顧者照護之參考及分享。

This article is about hospice care for a 54-year-old male who was diagnosed with liver cancer in January 2012. He was admitted to hospital due to recurrent gastrointestinal bleeding in September of that year. We assisted in the terminal care of this patient. During the period of nursing care from October 15 to November 27, 2012, management of his case focused on satisfying hospice care. To collect data, we had the benefit of personal nursing care, frequent conversations with the patient, observation, and chart review. The physical, psychological, social, and spiritual aspects of this case were integrated into a holistic nursing assessment. We found the following nursing problems: 1.The patient had limited knowledge about the nature of malignancy and subsequent pain, pain management, and how bone metastases can influence the course of disease. 2. He had a poor understanding about the subsequent grief and suffering his spouse might experience and how this might influence the final disposition of his case . 3. He experienced spiritual distress and desperation in the face of impending death. Based on the principles of hospice nursing care, we utilized appropriate nursing and pain control guidelines to alleviate the patient’s suffering. Companionship and conversations were used to minimize spiritual restlessness. Grief counseling was provided to the patient’s spouse in order to prepare her for the coming distress. With the patient and his family as the center of management, complete care was given. The medical team provided the patient, his family, and the whole team with a thorough treatment plan. Ultimately, with his family at his side, he completed his final journey in an atmosphere of peace and happiness. before transiting to the next life. With this valuable nursing experience, we hope to implement these concepts in clinical care and to provide terminally ill patients and their primary caretakers with a practical guide and a satisfying experience.