照顧一位肺癌末期臨終之護理經驗

A Nursing Experience of Caring for an End-of-life Lung Cancer Patient

本報告討論一位肺癌末期合併骨轉移與肋膜積水的個案，在初診斷肺癌後，病況立即持續惡化，且發現家屬面對病人死亡的迫近，有無助與哀愁感，故引發筆者想探討的動機。護理期間為2015年6月1日至2015年6月23日，運用Gordon十一項健康功能評估架構，藉由會談、觀察、傾聽及身體評估等方式資料收集，發現個案低效性呼吸型態、疼痛、皮膚完整性受損，以及家屬預期性哀傷等健康問題。經協助個案症狀緩解，漸進式調整氧氣模式、醫療團隊共同評估討論輔助性緩和症狀藥物使用，不斷給予家屬同理與支持，陪伴面對艱辛的臨終過程，最後個案善終回家。臨終照顧需照顧陪伴家屬，及其整個家庭，家屬的參與臨終照顧，可促使家人與病人臨終道別與道愛，讓彼此都無憾。建議護理人員需多參與臨終心理支持技巧的課程，應用於個案及家屬心靈層面之照護，以提升臨終癌症家庭關懷的品質。

The article described a nursing experience of caring for an end-of-life patient with metastatic lung cancer. The rapid progression of the disease right after initial diagnosis resulted in bone metastasis and pleural effusion. The patient's family appeared helpless and grieving as the patient's death was approaching. The nursing period was from June 1 to June 23, 2015. With Gordon's 11 functional health patterns assessment tool and the patient's physical assessment, the patient's care problems were identified to include ineffective breathing patterns, pain, impaired skin integrity, and anticipatory grief of family. Care interventions provided included relieving the patient's symptoms, progressively regulating oxygen supply, assessing use of medication through professional care team discussion, and providing consistent empathy and support to all family members during the period of hospice care, so they could express their love and say good-bye without feeling any regret. It is suggested that nurses should be trained to provide emotional support to terminally ill patients and their family to promote of the quality of end-of-life care.