照顧一位肺癌末期中年男性之護理經驗

A Middle-Aged Man Facing Terminal Lung Cancer: The Nursing Experience

本文描寫一位初次被診斷為肺癌末期中年之男性，因難以接受病情、不確定感，並且同時造成家庭衝擊之護理經驗。照護期間為2013年4月7日至2013年4月15日，筆者與個案及家庭建立信任關係，運用會談及Gordon十一項健康功能評估工具收集資料過程中，發現個案護理問題包括：因初次化學治療副作用導致有潛在危險性感染、對於疾病的不了解及預後不確定感而產生死亡焦慮及無效性家庭因應能力三個護理問題。護理過程中以生理的照護為優先，提供個別性預防白血球低下保護措施及居家照護指導，降低個案接受化學治療後的感染風險，其次運用接納、同理、鼓勵技巧及安寧團隊的介入，引發個案的希望，提高家庭因應此重大事件的能力，共同面對疾病。建議臨床癌症末期病人的照護，以健全照護指引及評估工具，再者運用跨團隊人員合作，如：社工、安寧共照師、癌症管理師及心理師等，能提供資源及專業課程，使護理人員在專業照護品質提升。

This case report describes the nursing experience with a middle-aged man who had a diagnosis of terminal lung cancer. The diagnosis was difficult to accept because of the uncertain prognosis and the impact on his family. The patient received care between 7 and 15 April 2013. Gordon’s eleven functional health assessment tool was used to establish a trusting relationship with the patient and family, and to collect information during the course of discussions. The chemotherapy side effects included potentially dangerous infections. The prognosis of the disease and the uncertainty of death generated anxiety and ineffective coping amongst the family. There were three nursing problems, as follows: provide individual protection measures to prevent leukopenia and home care strategies, thus reducing the risk of infection after chemotherapy; acceptance, empathy, and encouraging team skills and tranquility; and hope to improve family coping skills in facing the disease. To enhance the quality of care delivered by professional nurses caring for terminal cancer patients, it is recommended that care guidelines and assessment tools be improved for team members, such as social workers, hospice share care nurses, cancer case managers, and psychologists, and to provide the necessary resources and professional courses.