| 摘要: | 本研究主旨為探討安寧共同照護模式下癌末病患臨終經驗之研究，透過實際深入的訪談，得以瞭解在一般病房以此照護模式中癌末病患在臨終的經驗之八個範疇：癌末病患對醫療情境轉換的體會及罹癌時之置身處境、癌末病患生病時間歷程及關係的連結、癌末病患宗教信仰及生死觀、癌末病患安寧共同照護與治療感受及罹癌之心理層面。本研究的場域在南部某區域教學醫院的非安寧病房，本研究是採立意取樣，收集個案三人，以實際照護及參與觀察和深度訪談法進行資料收集，並以質性研究中的現象學作為研究結果的分析方法。 一、安寧共同照護模式下癌末病患的臨終置身處境：癌細胞侵蝕身體，臨終置身處境遭逢多重身體不適的症狀的疾苦，令病人食慾減少、徹夜輾轉難眠、無法解便、腫脹的肢體活動困難，身體形象改變令人難以接受，使病患感知死亡將至。緩解身體不適症狀、臨命終時落葉歸根的希望，能在熟悉安全溫馨的環境中，有摯親的陪伴，在安寧共照團隊的支持下是癌末病人置身處境最佳的歸屬。二、此模式下癌末病患的臨終壓力與挑戰：罹癌過程遭逢身、心、靈的痛苦，苦難的意義帶給病人不同的生命成長與體會，並藉由生命回顧回首不堪的歲月進行懺悔及告別，體認到人生盡頭終至此，隨順因緣順著生命的軌道走，生命終究是有意義與價值。三、此模式下臨終壓力與挑戰的調適方式：當歷經苦難經驗，希望能與至高無上的存有對話及感應，靈性開顯和至高無上的存有如信仰的佛菩薩、傳統民間信仰、耶穌基督及天主聖母瑪利亞內在的對話，能使精神上有寄託及心靈皈依處。四、此模式下的病人臨終經驗與安寧病房病人臨終經驗之感受：癌末病人藉由安寧共同照護協助舒適護理。癌末病人感受身體較為舒適，心理受到撫慰。因生理現象引起焦慮的情緒，在舒適護理下身心靈有被關照到。民眾對安寧病房的迷思是等死的地方，安寧共同照護的介入打破此迷思，為人性化照護模式的示範。
This research aims at exploring cancer patients' terminal experience under the hospice shared care model. Through depth-interviews, we learn to know the eight categories of their terminal experience in the general wards: the medical situation, the situatedness, temporal process of illness, connected relationship, religious belief, the view of life-and-death, feeling towards therapy, and the psychological dimension of cancer patients. The research field is located in the non-hospice ward of a regional teaching hospital in southern Taiwan. The research adopts the purposive sampling method and collects the data through actual care, participatory observation and depth-interview from three participants. The data are analyzed by the phenomenological qualitative method. The results are as follows: Firstly, regarding the terminal situation of cancer patients under the hospice shared care model. Due to the physical erosion by the cancer cells, the patients encountered multiple sufferings of discomfort in the terminal situation. They ate less, could not fall sleep, could not urinate, hard to move due to swollen body, and could not accept the physical image changed. All the signs made them aware of the approaching death. Under the model of hospice shared care, they hoped to reduce the physical discomforts, and to be warmly surrounded by the family members.Secondly, regarding the terminal pressure and challenges encountered. Encountering the physical, psychological and spiritual pain, the terminal patients explored the life meanings by way of life-reviewing, repentance and saying good-bye. They gradually recognized that life can still have meaning and value toward the end of life if we simply follow the natural flow of life. Thirdly, regarding the patients' adaptation to the pressure and challenges encountered. By way of having dialogue and telepathy with the Supreme High Beings, such as Buddha, Bodhisattva, Jesus Christ, Mother Maria, and so on, the terminal patients tend to have their spiritual refuge at the end. Fourthly, regarding the comparison between the terminal experience under hospice shared care model and that under hospice care. The terminal patients receiving the hospice shared care significantly improve the quality of life in the terminal situation. While the physical discomfort was reduced, the psychological anxiety caused by the physical pain was also cared. The myth, that hospice ward is a place for awaiting death, is then broken. The hospice shared care has set the fine example for the humane way of terminal caring. |
