106 Logotherapy for Recurrent-Cancer Death Anxiety 2007 Frankl, 1995/1988 Frankl, 1988 Pargament, Koenig, & Perez, cgy 2

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1 105 運用意義療法減輕癌症復發病患死亡焦慮之照護經驗 唐佩玲 1* 陳玟伶 2 鄭淑芬 3 1 高雄榮民總醫院護理部護理師暨高雄醫學大學護理學系博士生 附設中和紀念醫院護理部護理師 2 高雄醫學大學 3 高雄榮民總醫院護理部護理師 摘要 : 本文闡述運用意義療法概念及技巧, 於一位在接受鼻咽癌放射治療 1 年後, 因癌病復發面臨死亡 的心理衝擊與調適之護理經驗 照護期間為 2011 年 3 月 9 日 ~2011 年 4 月 21 日, 運用觀察 會談 電話訪談及與醫療團隊相關人員討論等方式收集 資料, 經由整體性護理評估發現病患護理問題有 死亡焦慮 疼痛 睡眠形態穩紊亂 而本文主要 描述運用意義療法的概念與技巧, 尊重病患且使 其明白自己目前的處境 選擇自己認為有意義的 生活方式, 漸進地轉化其生命意義, 減輕病患因 癌病復發後之死亡焦慮的照護經驗 關鍵詞 : 癌症復發 意義療法 死亡焦慮 % 5% 2001 Northouse Laten Reddy * [email protected] Northouse, Dorris, & Charron-Moore, Tang, Chiou, Lin, Wang, & Li, doi: /jn

2 106 Logotherapy for Recurrent-Cancer Death Anxiety 2007 Frankl, 1995/1988 Frankl, 1988 Pargament, Koenig, & Perez, cgy nasopharyngeal carcinoma ㈠ BMI body mass index ㈡ 我一闔眼, 可能就走了

3 107 ㈢ ㈣ 我真的很愛我的家人 治療太痛苦了, 我沒有辦法接受! 給洪先生及你自己 ( 指女友 ), 一些時間作調適與決定, 我們尊重您的決定 2. 生病後發生了哪些關鍵的事情, 對您是很有幫助的? 如改變了想法 心情或行動? 以前經商的時間, 很少陪伴家人 失敗後, 我非常孝順我的母親, 撫養四名子女, 自覺無做任何虧心事, 不知為何我會得到鼻咽癌, 實在無法接受命運的安排 生病後對自己 人生 生命意義有什麼新感受和看法? 我家人不會因我生病而不理我 ; 看他們為我每天出入醫院, 我的女友很辛苦 我真的要好好加油, 雖然沒有治癒的希望, 但我對他們還是有責任 您如何感謝她們及重新找到自己生命的重心與意義? 以前很少陪伴他們, 之後就生病了 我已經沒有多少時間了? 3. 生病令您感受最深刻或難熬的挫折是什麼? 生病後帶給家人很大的壓力, 她們 ( 指家人 ) 一直陪著我, 怕我心情不好! 你想陪伴他們的心情, 就如同他們想陪著你一樣, 那或許不是一種壓力, 而是彼此關心與愛的表現, 彼此在生病的困境中獲得體驗, 您何不主動將你的疑惑告知他們 由此可瞭解您對家庭很負責任, 您在年輕的時候辛苦的工作, 雖然失敗, 但您仍挑起一家的重擔, 您的孩子以你為榮 他們用心在照顧你, 肯定你對家庭是很有貢獻與價值的 4. 我知道疾病對你產生生活型態改變, 為了孩子, 你有什麼想法? 我想為他們面對治療, 至少可以控制我的疼痛, 不要讓我的大兒子失望, 我可以陪他打打桌球 你母親說你現在會與他一起去聽佛, 可談談你的心情嗎?

4 108 Logotherapy for Recurrent-Cancer Death Anxiety 以前對於宗教總是敬而遠之, 一個大男人信 教, 好像不像話 這心結, 直到聽了一位師父的開示, 才 開始鬆動 沒有多少時間了? 你在擔心會走到那條路! 每次唸阿彌陀佛, 電療好像就比較不那麼 辛苦了 這個感覺開啟了我對佛法的信念, 並在往後參加 共修時, 總不忘佛號唸得越大聲, 特別是為我的家人念佛 經 你現在最想作的事, 還有什麼? 我想要在看過的書旁寫上我的想法, 我想將 這些書留給我的小孩, 讓他們了解生病的我, 是怎樣的心 情, 作為他們日後的人生經驗 [Zhou, H., Yang, H. B., Tang, C. F., Liu, G. X., & Pan, Z. R. (2001). The 5-year death analysis in patients with nasopharyngeal carcinoma treated with radiotherapy. Journal of Clinical Otorhinolaryngology, 15(10), ] [Lin, J. J., & Gu, Y. L. (2005). The nursing experience of using Roy s adaptation model on an amputee. Tzu Chi Nursing Journal, 4(2), ] [Hung, F. C., Cheng, Y. R., Chiu, T. Y., Hu, W. Y., Chen, C. Y., & Wu, E. C. (1999). Psychosocial problems, coping strategies, and negative feelings in terminal cancer patients. Research in Applied Psychology, 3, ] 2003 NANDA 2003

5 [Kao, C. H. (Ed.)(2003). NANDA-I nursing diagnoses: Definitions & classification. Taipei City, Taiwan, ROC: Farseeing.] [Chang, L. J., Lin, C. L., & Hong, H. L. (2001). The relationship between self-concept discrepancy and death anxiety in medical and nursing students. Journal of Medical Education, 5(1), ] [Chen, R. B., & Huang, C. H. (2007). Logotherapy of the elderly about the frustration of control. Counseling & Guidance, 258, ] [Tsai, L. F., Kuo, M. L., Chen, S. C., & Chang, P. R. (2002). Needs of cancer patients during hospitalization. Chang Gung Nursing, 13(2), ] [Bhikkhuni, T. T., Bhikkhuni, H. Y., Chen, C. Y., Bhikkhuni, D. C., & Bhikkhu, H. M. (2007). Meaning of suffering and spiritual care of terminal patients. Taiwan Journal of Hospice Palliative Care, 12(1), ] Frankl, V. E [Frankl, V. E. (1988). The will to meaning: Foundations and applications of logotherapy (C. C. Chao & M. C. H. Shen, Trans.). Taipei City, Taiwan, ROC: KuanhChi Cultural Group.] Frankl, V. E. (1988). The will to meaning: Foundations and applications of logotherapy (Rei Exp. Ed.), London, England: Meridian. Northouse, L. L., Dorris, G., & Charron-Moore, C. (1995). Factors affecting couples adjustment to recurrent breast cancer. Social Science and Medicine, 41, Northouse, L. L., Laten, D., & Reddy, P. (1995). Adjustment of women and their husbands to recurrent breast cancer. Research in Nursing & Health, 18(6), Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), doi: /nur Tang, P. L., Chiou, C. P., Lin, H. S., Wang, C., & Liand, S. L. (2011). Correlates of death anxiety among Taiwanese cancer patients. Cancer Nursing, 34(4), doi: /ncc.0b013e c6

6 110 Logotherapy for Recurrent-Cancer Death Anxiety Using Logotherapy to Relieve Death Anxiety in a Patient With Recurrent Cancer: A Nursing Experience Pei-Ling Tang 1 * Wen-Ling Chen 2 Su-Fen Cheng 3 1 MSN, RN, Department of Nursing, Kaohsiung Veterans General Hospital and Doctoral Student, College of Nursing, Kaohsiung Medical University; 2 MSN, RN, Department of Nursing, Kaohsiung Medical University Hospital; 3 BSN, RN, Department of Nursing, Kaohsiung Veterans General Hospital. Abstract: We used logotherapy concepts to manage the mental impact of recurrent cancer on a patient. The patient had received radiotherapy for nasopharyngeal carcinoma approximately one year prior to the March 9th April 21st, 2011 nursing care period. The authors interacted with the patient during the care period via personal observation and telephone interview. Patient data was also collected from medical staff. Integral nursing assessment disclosed that the patient faced several major nursing issues, including death anxiety, pain, and sleep disturbance. This report describes how logotherapy was utilized to enable the patient better understand his condition and ultimately allow him to identify and pursue renewed meaning and happiness in life. Logotherapy helped alleviate the death anxiety caused by recurrent cancer and helped the patient self-reconfirm the meaning of life. Key Words: cancer recurrence, logotherapy, death anxiety. Accepted for publication: November 30, 2012 *Address correspondence to: Pei-Ling Tang, No. 386, Ta-Chung 1st Rd., Kaohsiung City 81362, Taiwan, ROC. Tel: +886 (7) ; [email protected]