照顧一位下咽癌末期合併肺轉移病人之護理經驗

Nursing Experience of an End-stage Hypopharyngeal Carcinoma Patient with Lung Metastases

本文是描述一位57歲男性因下咽癌末期合併肺轉移之病人，病人面臨癌症進展造成呼吸道症狀不適，更加感受到死亡產生焦慮；筆者於2020年12月4日至2020年12月29日護理期間；運用生理、心理、社會、靈性層面的評估，藉由家訪過程直接照護、筆談、觀察、溝通、電訪、查閱病歷、診斷報告及身體評估等技巧收集資料，確立病人有呼吸型態改變、皮膚完整性受損及死亡焦慮等健康問題；筆者提供穴位按摩、想像療法及肺部輔助運動等照護，改善呼吸困難症狀；運用失禁性皮膚炎照護促進傷口癒合；鼓勵及引導病人與家屬表達內心真實的感受，與家人間的不捨及擔憂，運用生命回顧肯定生命的意義及價值；更藉由死亡咖啡館方式偕同團隊人員，一同陪伴病人及家屬共同面對死亡，討論生後事及餘生期待，達到死亡準備、靈性平安及減輕死亡焦慮。末期病人的照顧除了涵蓋身心靈，也反應五全照顧的重要性，才能提供個別性及完善的照顧，期望此照顧經驗，提供照顧末期病人的護理人員做為參考。

This paper describes the nursing experience of a57-year-old male with terminal hypopharyngeal cancer and lung metastasis. The patient experienced discomfort from respiratory symptoms due to cancer progression and experienced death anxiety. During the nursing period from 4December 2020 to 29 December 2020, the author employed to assess of the patient's physiological, psychological, social, and spiritual aspects, as well as home visits. This was aimed at providing direct care to the patient. The author also conducted interviews, observations, communications with patient and his family, and telephone follow-ups. The author also reviewed medical records, diagnostic reports, and physical assessments. These activities were conducted to confirm the patient’s changing breathing patterns, disrupted skin integrity, and death anxiety. The author provided the patient with acupoint massage, imagery therapy, and assisted pulmonary exercises to improve dyspnea; and performed in-continence-associated dermatitis care to promote wound healing. The author also encouraged and guided the patient and family members to share their actual feelings, such as discussing the patient’s reluctance to and concerns about parting with the family. Alife review was employed to affirm the meaning and value of life. In addition, the death caféapproach was used with religious worker and their families to face death together, discuss afterlife matters and expectations for the rest of life to prepare for death, attain spiritual peace, and reduce death anxiety. In conclusion, the care of terminal patients should not only concentrate on body, mind, and soul but should also reflect the importance of“five whole cares”to provide personalized and comprehensive care. We hope that this nursing experience can provide afuture reference for nursing staff caring for terminal patients.