照護一位女性乳癌末期病人安寧療護之經驗

The Nursing Experience of a Woman with Breast Cancer in Terminal Stage

本文是描述一位女性乳癌末期病人之安寧療護經驗。筆者於2017年9月4日至9月30日期間，運用生理、心理、社會、靈性等四大層面進行整體性評估，以直接照護、觀察、會談、傾聽、團隊討論及病歷閱讀的方式收集資料，歸納出病人的健康問題有：呼吸喘、潛在危險性跌倒、口腔黏膜受損及抉擇衝突。在照護期間運用檸檬及薄荷精油芳香療法及夾式小電風扇吹向臉頰，搭配藥物治療以減輕呼吸喘；運用跌倒危險因子的辨識及採漸進式下床活動預防跌倒；每日檢視口腔及協助執行口腔護理改善口腔黏膜狀況；藉由陪伴、傾聽、溝通及討論，協助個案面對心理的困擾衝擊。結合團隊共同參與照護活動，讓個案症狀緩解返家，並接受本院安寧居家訪視之服務。期許分享此照護經驗，能提供未來照護此類末期病人之參考。

This article describes the nursing experience of caring for a woman with breast cancer in terminal stage. Immediately after being admitted to our hospital, she exhibited decisional conflict because of a difference in discharge-planning between her and family members. The author conducted a holistic assessment during the period between September 4 to 30, 2017, covering physical, psychological, social, and spiritual dimensions, and collecting data through interaction with the patient, such as providing direct care, observing, talking and listening to her. Moreover, the author also gathered information from discussions with team members and read the patient´s relevant medical records. The health problems recognized were: breathlessness, risk for falls, impaired oral mucous membrane, and decisional conflict. The author used aromatherapy of lemon and peppermint essential oil, employed a clip-type electric fan to sooth the patient ´s cheek, provided medications to reduce her discomfort during breathing, identified risk factor for falls, and taught her how to get out of bed progresively to prevent falling. The author checked the patient´s oral condition every day, assisted her with mouth care, and improved oral mucosa discomfort. Moreover, the author kept company, listening, communication and discussion with the client to assist her facing the psychological impact. Through professional joint efforts, the patient´s symptoms relieved and decided to return home and receive palliative home visits afterwards. The author wishes to present this case to share her hospital´s way of providing care to a terminally ill patient, which may be helpful to other healthcare professionals.