一位肺腺癌末期呼吸器依賴病人撤除維生醫療之護理經驗

Nursing Experience of a Lung Cancer Patient Who Relied on Ventilator Withdrawing Life-Sustaining Treatment in End-of-Life

本文乃探討一位肺腺癌末期病人，此次因右上肺腺癌併多發性骨轉移導致呼吸困難，須長期使用呼吸器維持生命。面臨疾病造成的身體不適，如:呼吸困難、疼痛，以及個案希望能活的有尊嚴不想被疾病折磨，最後抉擇撤除維生醫療系統，而產生生命最後旅程之預期性哀傷。護理期間自2020年11月30日至2020年12月20日，透過觀察、會談、電子病歷收集相關資料，運用生理、心理、社會、靈性做整體性評估，確立主要護理問題低效性呼吸型態、疼痛、預期性哀傷。護理過程中個案因肺癌末期吸氣吐氣無法提供足夠的換氣導致低效性呼吸型態，除呼吸器使用的相關照護外，需留意痰液蓄積及協助採舒適臥位等，以維持適當氧合。藉由疼痛評估，給予精油按摩等方式轉移注意力，依醫囑給予藥物減緩不適。建立良好的護病關係，運用安寧照護理念瞭解個案及家屬對撤除維生醫療的認知及共識，適當提供相關訊息共同擬定照護計畫，協助完成四道人生。經由此次照護經驗，建議先瞭解病人及家屬對末期疾病照護期待及認知，提早給予安寧相關資訊，並增加護理人員安寧末期靈性照護相關教育訓練與自信，進而提高疾病末期照護品質。

This article describes a terminal lung caner patient who is long termventilator-dependent because of right upper lung adenocarcinoma with bone metastasis. He and his family faced the expected grief due to the patient's uncomfortable experiences of dyspnea and pain. Hoping to live with dignity, he decided to stop life-sustaining treatment in the terminal stage of the disease. The nursing period was from November 30 to December20, 2020. Data were collected through observation, interview and electronic medical records. Patient's physiological, psychological, social and spiritual aspects were comprehensively assessed.The patient's health problems, includingineffective breathing pattern, pain, and anticipatory grieving. In ineffective breathing pattern, we not only provided ventilator nursing care,but also assessed sputum and ability of cough,and help lying comfortable posture to maintain proper oxygen saturation.After assessing patient's pain, we used aromatherapy massage and other methods to divert patient's attention in pain,and gave drug by order to reduce uncomfortable feeling. In addition, we have established a good relationship with patients, trying to use the concept of hospice care to understand the cognition of patients and his family on withdrawing life-sustaining and provide appropriate information to jointly develop a care plan. Finally, the family was guided to express their feelings of apology, love, gratitude, and say goodbye to the patient. Through this nursing experience, we suggest understanding patients and their family's expectations and cognitions of end-of life care, giving information about hospice care as early as possible, and increasing hospice care education for nurses to improve the quality of end-of-life care.