癌末瀕死時躁動不安之現象學探討

A Phenomenological Inquiry on Caring Terminal Cancer Patients in Dying Agitation

研究目的：癌末病人瀕死時常發生躁動不安，本文旨探討躁動不安與片段記憶的關係。研究方法：本研究針對台灣南部某醫學中心安寧病房，以立意取樣十位癌末瀕死病人，透過田野調查法和參與觀察法收集資料，並藉用現象學方法分析文本。研究結果：本研究發現當躁動不安發生時在時間結構上會跟著變動，而癌末病人會透過回憶、想像到回到過去自身片段記憶中，身體也隨著病程進展體力衰退，造成自我結構改變最後退出社會脈絡。研究結論：本文研究結果重新開展癌末瀕死時躁動不安的空間，揭露新的「整合片段記憶融入躁動不安」照顧模式，可補充現有的「生物精神醫學」、「安寧療護」、「臨終過程四階段」醫療模式，更擴及到護理教育與臨床實務。

Purpose: Dying agitation is a common occurrence at the end of terminal cancer patients’ lives. The purpose of this article is to explore how agitation integrated with shattered remembrances are correlatively developed in the dying phase. Methods: By conducting phenomenological analysis on cases, using field method and participant observation method, this study emerges from field data collected from ten dying persons in a hospice ward of a southern Taiwan Medical Center. Results: This finding shows that a terminal cancer patient will gradually shed his or her social identified ego parts, as a result of
the progressive shutdown of multiple body systems which results in dying agitation. Dying agitation is associated with a dying person’s lived experience, which is composed of flash memory, imagination and temporality of his or her shattered remembrances. Conclusions: This study explores an alternative approach to dying agitation and offers assessment connection with shattered remembrances for terminal cancer patients in the dying phase. Based on these findings, it may imply further research and as support for training nurse’s education and clinical practice.