一位肝癌末期長者在宅善終之居家護理經驗

Nursing Care of Home Hospice for an Elder with End-stage Hepatocellular Carcinoma

本文描述完成肝癌末期長者在宅善終心願；護理期間於2016年2月2日至2月17日，共訪視7次，電訪3次，評估架構運用整體性層面，以會談、觀察、身體評估收集資料，確立主要健康問題有：慢性疼痛與肝腫瘤及腹水壓迫有關；預期性哀傷與家屬即將面臨親人死亡有關。於訪視期間與個案及家屬建立良好信賴關係，主動關懷案家，協同醫師到宅診視個案及開立疼痛貼片使用，與家屬共同製作防水翻身中單及使用L型枕以利移位翻身及舒適擺位，教導採集中照護方式、播放個案喜愛的音樂及運用芳香療法按摩，使疼痛分數由6分降為2分；聯繫家屬與醫療團隊召開家庭會議，尊重個案在宅善終意願，讓家屬彼此傾訴內心感受，瞭解案媳沉重的身心壓力，進而案女幫忙分擔輪流照顧；運用舊時照片與病人做生命回顧，引導家屬向病人做四道人生，安寧醫療居家團隊幫忙完成個案心願，協助長孫在家舉行簡單隆重訂婚儀式，使個案完成善終及家屬哀傷得以抒解。

The purpose of the paper is to describe nursing process to fulfill the wish of dying at home for an elder with end-stage hepatocellular carcinoma. The care period was from February 2nd, 2016 to February 17th, 2016, during which time seven visitations and three telephone visits in total were conducted. The assessment framework comprises overall aspects, including interviews, observations and data of physical assessments. The main health problems established were: chronic pain related to hepatocellular carcinoma and ascites oppression; expected grief related to family members facing the death of loved ones. During the visitation period, a good and trusting relationship was established with the subject of the case study and his family members. The researcher took the initiative to show concern to the case study’s family and accompanied the physician to visit the subject’s home and prescribe pain patches. With the involvement of the family members, water-proof body turning bed pads and L-shaped pillows were made to facilitate body turning and comfortable placement, as well as giving instructions on cohort care. The subject’s favorite music was played, while aromatherapy massage was applied to lower the pain scale from six to two. The researcher also contacted family members to hold family meetings with the medical team. The case study’s wish to have“home hospice”was respected and the family members to expressed their inner feelings. The researcher was able to understand the enormous physical and mental stress the subject’s daughter in-law was under, thus sharing her work load with the subject’s daughter by taking turns to render care to the subject. Old photos were used to look back on the patient’s life in the patient’s presence. The family members were also guided to show the patient the“gratitude, remorse, love, and farewell”. The home palliative and hospice care team also fulfilled the case study’s wish by offering assistance at his grandson’s simple and solemn engagement ceremony at home, thereby completing the case study’s“home hospice”and alleviating the family members’grief.