頁籤選單縮合
題 名 | 面對一位未被告知罹患肺癌患者之護理經驗=Nursing Experience of Moral Distress for an Uninformed Lung Cancer Patient |
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作 者 | 陳怡樺; 董道興; 師慧娟; | 書刊名 | 腫瘤護理雜誌 |
卷 期 | 5:1 2005.06[民94.06] |
頁 次 | 頁47-57 |
分類號 | 419.77 |
關鍵詞 | 癌症; 生命尊嚴; 病情告知; 倫理困境; Cancer; Human dignity; Inform concern; Ethical dilemma; |
語 文 | 中文(Chinese) |
中文摘要 | 惡性腫瘤近年來一直位居十大死因之首位。醫療科技的進步,使得癌症患者的生命獲得延緩,但生活品質與生命尊嚴卻面臨考驗。本篇個案是肺癌末期病人,因呼吸困難、胸痛入院,住院期間藉由觀察、會談,並依Gordon十一項功能健康型態爲評估工具,確立其主要問題為慢性疼痛及低效性呼吸型態。根據其問題,筆者提供疼痛控制及改善呼吸困難之護理措施,更輔以音樂與芳香療法,期望能減輕個案的症狀,進而增加其疾病末期之生活品質。但在護理期間,家屬一方面害怕個案知道自己的病情嚴重及無法承受罹癌的事實,故要求醫療人員隱瞞病情,甚至拒絕醫師或護理人員提供之醫護措施,另一方面,又擔心隱瞞病情可能會造成個案的遺憾,因此筆者針對「病情告知」在家屬內心造成的掙扎與衝突,另立抉擇衝突/與家屬有關之護理診斷。經過與家屬多次的討論及溝通有關病情告知與不告知的正負面影響,協助家屬作正確的決定,進而願意配合治療,以使個案獲得完整性的照顧。筆者希望藉此個案之護理經驗,提供護理同儕在面對與「病情告知」有關之倫理議題時,能如何周全考量病人『知』的權力,並兼顧家庭、醫學倫理之觀點及法律條例之規定,以展現護理專業的獨立性功能,進而提升照護品質之參考。 |
英文摘要 | In Taiwan, malignancy has been the leading cause of death in recent years. Due to the progress in medical science and technology, lives of cancer patients have been extended, but their life quality and dignity encounter anguish. This is a case report about a terminal stage lung cancer patient admitted to hospital because of dyspnea and chest ache. The nursing process is evaluated with Gordon's 11 functional patterns. Related data were collected by evaluation, observation, and interview with the patient and family. Our study revealed two problems: chronic pain and ineffective breathing pattern. Nursing cares to relief pain and improve breathing efficiency were provided, combined with music and fragrance treatment, hoping to lighten his symptoms. However, as the relative are worried that the patient not unable to accept the fact of terminal cancer, they required medical personnel to conceal the truth. They also refused our nursing processes such as bed side health education several times as they were afraid that the patient might begin to suspect he had cancer. After further understanding of the family's struggle and confrontation whether the "truth of the condition" should be told, the third question, choice conflict (relative) was established. After many meetings, positive and negative impacts of whether to tell or not to tell the patient about his cancer were discussed thoroughly with the relatives. This helped relatives to make the correct decision, they then cooperated with the treatment and nursing care, and the patient obtained complete treatment. After encountering this case, the author was then impelled to investigate cancer patients' right to know in clinical situation, and to analyze the rationale of whether to "inform" or "not to inform" from the view points of medical ethics, law and codes, and family ethics. By presenting this ethical dilemma, the author hope the quality of nursing care can be enhances. |
本系統中英文摘要資訊取自各篇刊載內容。