運用安寧療護理念於 一位食道癌末期病患之護理經驗 許惠凱林美娟 * 摘要 : 本文描述照護一位食道癌末期病患臨終前的護理經驗, 護理期間為 200 年 11 月 8 日至 11 月 0 日 以個案為中心, 透過觀察和筆談, 進行身體 心理 社會及靈性評估, 發現個案於住院期間有 疼痛 呼吸道清除功能失效 預期性哀傷及心靈 困擾等健康問題 照護過程中, 筆者依 安寧療 護 工作理念, 以主動關懷 同理心 陪伴 傾 聽 支持等方式, 幫助個案克服面對死亡的恐懼 與哀傷 ; 並運用舒適照顧與疼痛控制技巧, 緩解 個案身體上之不適, 使其身 心 社會 靈性 獲得安適, 達到 善終 的境界 關鍵詞 : 食道癌末期 安寧療護 善終 2008 2001 2000 200 * 98 2 99 2 8008 100 0 20820 200 200 2001 Rose, 199 200 Pruzinsky, 200 200 200 Parran 200
Applying Hospice Care on Terminal Cancer Patient McFarland & Mc- Farlane, 199/200 200 200 200 199 200 200 8 200 11 8 2 200 11 8 200 11 0 12.1 20% 21 我背跟胸像有千萬針在刺, 好痛, 怎麼睡! 喉嚨一直有痰咳不出來! 1 1 2
叫醫生來 怎麼辦? 我要死了! 好怕沒伴!! 痛苦!!! 為什麼這麼快!! 更嚴重了! 神沒看顧我? 為什麼是我? 是神旨意? 神會赦免 ( 我的 ) 罪? 天使會來 ( 接我 )?? 到 ( 神 ) 那裡就不痛苦? 11 10 11 30 11 8 11 9 咳 嗽時左胸會痛, 背部也常會痛! 我背跟胸像有千萬支 針在刺, 好痛, 怎麼睡! 2C-spine MRI Bone Scan C1 Metastasis 11 8 11 9 11 8 11 9 8 10 11 8 11 9 100 10 11 12 Pethidine 0mg Durogesic 2ug Morphine 10mg 11 2 11 2 Morphine 0mg Durogesic 2ug
Applying Hospice Care on Terminal Cancer Patient 11 23 11 30 11 20 11 22 痰 好多, 常抽很不舒服! 11 20 1 2 8 Bisolvon ml + N/S ml Tazocin 2.2g 2vial 1000 ml 1 11 28 1 2 2 11 24 11 30 11 21 日子不多了,( 病 情 ) 變化真快! 怎麼辦? 快死了! 好怕! ( 我 ) 欠 ( 太太 ) 很多 想見女友! 為什麼這麼快!! 11 21 11 22 11 2 11 28 11 24 11 30 11 21 11 2 更 嚴重了! 神沒看顧我? 為什麼是我? 是神旨意? 天使會來 ( 接我 )?? 到 ( 神 ) 那裡就不痛苦? 打 針 ( 讓我在 ) 睡 ( 夢中 ) 死去 11 21 11 2 CD 11 2 11 0 CD
2008 [Department of Health, Executive Yuan. (2008). Health statistics data for 2007. Taipei, Taiwan, ROC: Author.] 2001 28 12 1 21 [Chiu, T. Y. (2001). Pain control terminal cancer patients. Medicine Today, 28(12), 1 21.] 200 10 2 22 [Chuang, R. B., Lee, I. F., Chiu, T. Y., Wang, J. Z., Lai, Y. L., & Hsiao, S. C. (200). A preliminary experience of hospice shared-care model in Taiwan. Taiwan Journal of Hospice Palliative Care, 10(), 2 22.] 200 181 [Chen, Y. J. (200). The Spiritual needs and spiritual care of terminal stage patients. Tzu Chi Medical Journal, 18(), 1.] 200 81 [Chen, C. Y. (200). The spiritual care model for end-stage cancer patients in Taiwan. Formosa Journal of Medicine, 8(), 1.] 200 2 1 9 1 [Chang, M. C. (200). Esophageal cancer. Medicine Today, 32(1), 9 1.] 200 2 11 1 [Tseng, Y. H. (200). Aromatherapy in nursing practice. The Journal of Nursing, 52(), 11 1.] 200 22 2 2 [Tsen, Y. F., Tu, M. H., & Chen, R. Y. (200). Spiritual care and good death for terminal stage patients. Primary Medical Care & Family Medicine, 22(2), 2.] 199 1 8 [Chao, C. S. (199). The meaning of good dying for terminal cancer patient in Taiwan. The Journal of Nursing, 44(1), 8.] 200 1 2 80 [Lo, H. M., Hsu, N. L., Chin, H. J., Liao, W. E., & Liu, S. Y. (200). The Investigation of the relationship between symptom distress and uncertainty. Tzu Chi Nursing Journal, 3(1), 2 80.] McFarland, G. K., & McFarlane, E. A. 200 199 [McFarland, G. K., & McFarlane, E. A. (200). Nursing diagnosis & intervention: Planning for patient care (Chou, S. S., Ou, J. M., Cai, S. H., Kang, B. S., Ye, M. Z., Zhang, B. Y., et al., Trans.). Taipei, Taiwan, ROC: Farseeing. (Original work published 199)] Parran, L. (2003). Spiritual care is elemental and fundamental to the heart. Oncology Nursing Society News, 18(3), 4 5. Pruzinsky, T. (2004). Enhancing quality of life in medical populations: A vision for body image assessment and rehabilitation as standards of care. Body Image, 1(1), 17 81. Rose, K. E. (1997). Pain management in advanced cancer. Nursing Standard, 11(17), 49 55.
8 Applying Hospice Care on Terminal Cancer Patient Applying Hospice Care Concepts on a Patient With Terminal Stage Esophageal Carcinoma: A Nurse s Experience Hui-Kai Hsu Mei-Chuan Lin * Abstract: This report describes a nursing care experience with a patient diagnosed with terminal stage esophageal carcinoma. Nursing care was administered from November 8th to 30th, 2007. Patient data was collected and evaluated using direct caring, observation, medical reports and patient interviews covering the physical, psychological, social, and spiritual realms. Patient health problems included pain, ineffective airway clearance, anticipatory grieving and spiritual distress. In line with hospice care concepts, the author employed empathy, companionship, listening, and support to assist the patient to overcome fear and face death. Comfort care and pain control skills were also used to relieve the patient s physical suffering. As such, the author assisted patient to achieve the essence of good death, i.e., peace of achieved in the physical, psychological, social and spiritual realms. Key Words: esophageal carcinoma in terminal stage, hospice care, good death. RN, BSN, Department of General Surgery Medicine, Kaohsiung Medical University Hospital; *RN, MHRM, Head Nurse, Department of General Surgery Medicine, Kaohsiung Medical University Hospital. Received: April 2, 2009 Revised: August 16, 2009 Accepted: February 4, 2010 Address correspondence to: Mei-Chuan Lin, No. 100, Tzyou 1st Rd., Kaohsiung 80708, Taiwan, ROC. Tel: +886 (7) 320-8207; E-mail: 850185@cc.kmuh.org.tw