一位肺癌末期合併肋膜積水病患及其主要照顧者之護理經驗

Nursing Experience with a Patient with Terminal Lung Cancer and Pleural Effusion and His Primary Caregiver

本文描述一位肺癌併肋膜積水個案，因疾病進展不如個案所預期，使個案及主要照顧者對導管留置產生負面心理之護理經驗。個案因導管須長期置放，且與年紀大的案妻相互依賴，無人分擔照顧工作，引發筆者於2012年1月2日至2012年1月18日照護期間，運用Gordon十一項健康功能型態為評估架構，藉由會談、觀察、傾聽及身體評估完成資料收集，發現個案除肋膜積水引發呼吸喘問題，並因病情進展不確定感到擔心，對於導管需長期放置的困擾及引流液異味讓個案產生自卑羞愧，以及主要照護者擔心無法勝任照護者角色，分析歸納個案有低效性呼吸型態、身體心像紊亂及照護者角色緊張等護理問題。護理過程以增進舒適為首要目標，先緩解肋膜積水所引起的呼吸喘問題，陪伴渡過不安害怕情緒，利用修飾技巧遮蔽導管並降低傷口惡臭程度，使個案能接受導管置放造成身體外觀改變，適應改變維持生活品質。再者，透過實際操作及回覆示教方式，讓案妻學習照顧技巧減輕主要照顧者壓力，並能勝任主要照顧者角色。筆者建議臨床於癌症末期個案照顧重心，應合併主動關懷主要照護者之需要，以達更完善之護理品質。

This article recounts our nursing experience with a 80 year old male patient suffering from lung cancer with pleural effusion and negative feeling caused by the unpredictability of the disease progression and the insertion of a long term drain. During the nursing period (Jan. 2nd to Jan. 18th 2012), we interviewed and carefully observed the patient and evaluated his physical condition based on “Gordon’s 11 Functional Health Patterns”. The pleural effusion caused shortness of breath, and the patient was anxious about the uncertainty of his disease progression. He needed to have a long term drain and was embarrassed about the smell from it and felt ashamed. The patient lived with his wife who was his only caregiver; they depended on each other and no one shared the care work. His wife was afraid that she could not offer him proper care and was exhausted. We not only took care of the patient with terminal cancer but were actively concerned about his caregiver. First, we made the patient feel comfortable during the nursing process and then relieved his shortness of breath and addressed his anxiety. We taught the patient and his caregiver how to care for the drain and reduce the odor of the wounds. Then, we helped the patient accept the changes in his appearance cause by placement of the drain. We believe that his wife had less stress as long as she knew how to properly care for the patient. We suggest that clinical care of a terminal cancer patient should focus not only on the patient but also include concern for the primarily caregiver in order to achieve a better quality of care.