運用安寧療護於一位胃癌末期病人的護理經驗

Palliative Care on a Patient with terminally Gastric Cancer

本文旨在探討運用安寧療護於一位胃癌末期病人之護理經驗，護理期間自2014年2月17日至2014年3月31日止，運用會談、觀察、身體評估及查閱病歷方式收集資料，以生理、心理、靈性及社會層面進行整體性評估，確認主要的護理問題為癌症疼痛、無望感及心靈困擾。護理過程中除了主動評估疼痛程度及調整止痛劑劑量，並提供輔助性治療如精油按摩及聆聽音樂等措施緩解疼痛。藉由陪伴、主動傾聽、引導回顧生命的價值、重新賦予事件意義等方式提升個案的希望感。藉由鼓勵案夫及案子每日陪伴時做肢體上的觸摸、製作卡片或錄音方式留下紀念，並提供正向意義治療，去實踐生命意義之反思後重新修復四個面向之關係，最終個案能坦然、不恐懼的面對死亡，得到靈性上的平安。希望藉由此個案報告與經驗分享，能對日後照顧此類癌症病人之護理同仁有所助益。

The purpose of this article was to explore the palliative care nursing experience of a hospice patient with advanced gastric cancer. The caring period was from February 17th to March 31th in 2014. Patient assessment data were collected through observation, interview, physical assessment, and review of medical records, with the focus on the patient's physical, psychological, spiritual, and social aspects. Major nursing health problems included cancer pain, hopelessness, and spiritual distress were noted. Nursing care interventions included assessing pain intensity actively, adjusting analgesic dose, and also giving adjuvant therapy such as aromatherapy massage and music therapy to relief pain. Then enhance the patient's sense of hope by companying, listening, reviewing the value of life, and reassign the significance of event. We also suggested family to contact the patient physically each day and make card and tape to memory her then helped her to get good death so that her family had no regret either. Finally, they calmed to get spiritual peace and restored the four-oriented relationship practice reflections on the meaning of life. We expected this experience will be a valuable reference and inspiration for nursing staff while providing high quality of care to the terminal cancer patients.