運用安寧療護理念照護一位食道癌末期病人之護理經驗

Hospice Care Nursing Experience of a Patient with Terminal Stage Esophageal Cancer

本文描述一位食道癌病人已行食道重建、化學及放射線治療後，本以為疾病受到控制，此次呼吸喘及肋膜積水，檢查後發現肺轉移且疾病進展快速，感受生命受威脅，對未來感到無望，同時造成家庭衝擊，故引發筆者探討動機，護理期間自2018年3月22日至4月17日，透過Gordon十一項功能性健康型態評估，確立有低效性呼吸型態、疼痛及無望感。照護過程藉由持續性關懷，及依個別性給予精油按摩、轉移注意力等技巧，來緩解疼痛及呼吸喘。針對無望感則利用與家人回顧過往的生活點滴，鼓勵說出內心感受，讓個案對過去的經歷有正向情緒，且運用安寧療護理念整合醫療團隊給予心理諮商、安寧共同照護、居家安寧團隊、轉介心理諮商師及出院服務準備，以得到完善的醫療資源，減輕家屬照護的緊張感，亦可讓個案降低其無望感，使個案去計畫僅剩的未來，並選擇在熟悉的居家環境中走完人生最後一程。建議及早會診安寧共同照護或心理諮商師，以團隊資源及家庭力量的支持，整體持續關懷癌末病人，提升全人護理照護品質，期望此經驗能提供照護類似病人之參考。

This article describes a patient with esophageal cancer had been treated with esophageal reconstruction, chemotherapy and radial therapy successfully. However, he suffered from shortness of breath with pleural effusion, and the following survey revealed lung metastasis. Therefore, he felt hopeless future of life, and this condition leads to a massive impact on his families. The above situation triggered the author's motivation to explore the patient's nursing care. The duration of nursing care was between March 22 to April 17, 2018, by using Gordon's element item health assessment scale and established the following nursing care issues: dyspnea, pain and hopelessness, we gave patient individualized care and distracting skills for relieving his pain and dyspnea. For improving his sense of hopelessness, we encourage him to review his past life with his family and talk about his inner feelings for positive emotion about his past experiences. At the same time, we used the concept of hospice care to integrate the medical team to provide discharge service preparation and reducing the stress of his family care. The patient also chose to complete his final course of life in a familiar home environment. For such a patient, we recommend that early consultation the hospice care team, effectively using the supporting system of medical resources and family support for patient to improve the quality of care. The objective was to share the nursing experience with clinical nursing staff caring for cancer terminal patients.