照顧一位胰臟內分泌腫瘤末期個案之臨終護理經驗

Experience of Nurses in Providing Hospice Care to a Patient with End-Stage Pancreatic Neuroendocrine Tumor: a Case Report

胰臟內分泌腫瘤為罕見疾病，初發病經治療後常見效果不佳，疾病多進展到末期，本個案為年輕女性，人生原本計劃到國外求學後，與論及婚嫁男友結婚，確診疾病持續治療後，病程每況愈下，至今不僅身體面臨症狀的侵擾，治療有限而對未來失去信心，心靈也因面臨死亡與家人分離，感到害怕不安，每日承受身心靈的痛苦煎熬。筆者透過直接照顧及觀察會談，與安寧團隊共同提供照顧，照護期間2017年12月5日至2018年1月6日，以Gordon十一項健康功能型態評估收集資料，發現護理問題有體溫過高、疼痛、心靈困擾、預期性哀傷。在住院治療期間，以陪伴傾聽及主動提供關懷，讓個案轉變正向態度，尋求心靈上的寄望，與家屬陪伴能相互傾訴。在臨終階段，個案願意接受宗教支持，轉變心境以正向信念接受疾病進展變化，在家人的親情圍繞，互相溝通對後事的準備，坦然面對死亡及與家人道別，讓心靈重獲安適狀態，順利渡過人生最後旅程。建議早期推動宣導安寧療護，團隊共同參與病患家屬的照顧，讓病患在末期階段獲得善終，減少不必要處置，承受多餘的痛楚，以此照顧經驗分享。

Pancreatic neuroendocrine tumor is a rare disease. In the early stage, the symptoms are often poor after treatment. The disease then progresses to the end stage. Herein, we report the case of a 30-year-old girl. She previously had a satisfying life with fine projects and had plans to study abroad. Moreover, she even wanted to get married. However, these plans could not be carried out because she was not healthy. In spite of continuous treatment of the disease, it still progressed from bad to worse. Thus, she had to deal with the symptoms as well as accept the fact that the treatment is limited. As a result, she lost hope for the future. Furthermore, she was anxious of death and family separation, which added to her sufferings. The author along with the tranquility team provided high-quality hospice care. During the care period from December 5, 2017 to January 6, 2018, the Gordon's eleven functional help pattern was used for the assessment, and the following nursing caring problems were identified: hyperthermia, pain, spiritual distress, and anticipatory grieving. During the treatment in the hospital, the author accompanied the patient and took the initiative to provide care. Therefore, she gained positive attitude and hope. Toward the end of life, she trusted religion to give support and accepted the progress of the disease with a positive attitude. She accepted death with trust, acceptance, and hope. Moreover, she was accompanied by her family. She communicated with them and said goodbye to them. Her soul regained comfort, and she had a smooth journey until death. We had recommended to promote hospice care early. The patient can receive positive support, and can face the final stage to get a good end. Therefore, we shared this care experience with clinical caregivers.