協助一位罹患淋巴癌之學齡期病童及家庭渡過危機之護理經驗

Nursing Experience in Supporting a School-Aged Pediatric Patient with Lymphoma and his Family through the Crisis

10.29494/LN.202312_24(4).0004

李玉貴(Yu-Kuei Li)；吳香勳(Hsiang-Hsun Wu)

淋巴癌 ； 學齡期病童 ； 照顧者角色緊張 ； Lymphoma ； school-aged pediatric patient ； caregiver role strain

領導護理

24卷4期（2023 / 12 / 01）

34 - 49

繁體中文;英文

本文闡述一位罹患淋巴癌學齡期病童之護理經驗，個案在非預期下被宣判罹癌，內心遭受衝擊與不確定感，導致生、心及社會各層面威脅及壓力，看著病童面對無助的情境及主要照顧者因自責不知如何面對未來，故引發筆者之動機。於2020年8月19日至2020年9月14日照護期間，藉由觀察、會談、直接照護、病歷查閱及Gordon十一項健康功能性模式做整體性評估，發現個案有潛在性危險性感染、焦慮、照顧者角色緊張等健康問題。護理過程中，以簡單明瞭衛教輔助工具強化認知減少潛在危險性感染；善用人工血管模型或醫療動漫故事說明療程，降低治療時造成的焦慮及害怕感。透過陪伴、傾聽、提供宣洩情緒管道、參與跨團隊會議等共同討論治療計劃，以減輕家庭經濟壓力及照顧者緊張。建議罹癌病童應早期啟動跨團隊運作，從門診即可由個案管理師介入，住院時進行資訊連結，讓其降低心理衝擊與焦慮，提升返家後自我照護遵從性及回歸正常生活，期望能提供爾後照護此類個案之參考，進而提升護理照護品質。

This article describes the nursing experience of a pediatric patient with lymphoma. The case was unexpectedly diagnosed with cancer, suffers from shock and uncertainty which leads to threats and pressures from all levels of physical, psychological and sociological. Watching the patient facing the helpless situation and the primary caregiver's self-blame for not knowing how to deal with the future triggered the author's motivation. During the nursing period from August 19 to September 14 in 2020, through observation, interview, direct care, medical record review, and Gordon’s Eleven Health Functional Patterns for an overall assessment, the case was identified to encounter potentially dangerous infection, anxiety, caregiver role stress and other health issues. During the nursing process, simple and clear health education aids are used to strengthen cognition to reduce potentially dangerous infections; make good use of artificial blood vessel models or medical animation to illustrate the course of treatment, so as to reduce anxiety and fear during treatment. Through companionship, listening, providing channels for venting emotions, and participating in cross-team meetings to discuss treatment plans together to reduce family financial pressure and caregivers’ tension. It is suggested that children suffering from cancer should start cross-team operation early, and the case manager can intervene from the outpatient clinic. Information linking can be carried out during hospitalization, so that they can reduce psychological impact and anxiety, improve self-care compliance and return to normal life after returning home. Hopefully this experience can provide a reference for subsequent care of such cases to improve the quality of nursing care.

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