照顧一位青少年罹患胸腺癌之護理經驗

NURSING EXPERIENCE OF CARING FOR AN ADOLESCENT PATIENT WITH MALIGNANT THYMOMA

10.3966/156104972021122002006

洪銘佳(Ming-Chia Hung)；侯慧明(Hui-Ming Hou)；林品樺(Pin-Hua Lin)；李孟樺(Meng-Hua Li)

青少年 ； 胸腺癌 ； 疼痛 ； 身體心像紊亂 ； 無望感 ； Adolescent ； Malignant thymoma ； Acute pain ； Body image disturbance ； Hopelessness

秀傳醫學雜誌

20卷2期（2021 / 12 / 01）

113 - 121

繁體中文

本文在探討一位青少年罹患胸腺癌之護理經驗，胸腺癌在各年齡層是相當罕見疾病，個案因疾病及治療過程所造成之副作用，嚴重影響個案心理狀態，導致產生排斥治療心態。護理期間為2018年12月12日至2018年12月25日，筆者採用Gordon十一項健康功能型態護理評估工具，確立個案有急性疼痛、睡眠型態紊亂、身體心像紊亂、無望感等護理問題。護理過程採集中式護理，以觀察、同理心等技巧來建立信任關係，提供個別性護理衛教提升照護能力，介紹年紀相仿病友及支持性團體使其能坦然面對疾病發展、配合治療改善病症，鼓勵家庭及重要他人支持使個案重新找回生活意義及社會適應能力。透過此護理經驗，提供未來照護此類個案之參考，期望能達到身、心、靈完善照護。

The aims of this case report were to explore the nursing experience of a adolescent with malignant thymoma. The client refused to receive treatment because of the disease and the side effects of treament which affect psychological states, leading to rejection of treatment. The nursing period was from December 12, 2018 to December 25, 2018. The Gordon's functional health assessment guide was used to assess nursing problems through observation, interview, listening, and physical examination. The nursing problems included acute pain, sleeping disturbance, body image disturbance, and hopelessness. During the period of care, the author provided active listening, caring, and medical and alternative interventions to assist in pain relief, centralize nursing, reduce external environmental stimuli and improve sleep pattern disorders. We used observation and empathy skills to build a trust relationship and guide the patient to express his emotion, and provided individual nursing instruction and health education guidance to enhance the self-care ability of the client and his family. We further introduced patients of similar age and support groups to enable the patient to face the development of the disease, cooperate with the treatment to improve the disease, and encourage the family and important others to assit the patient in regaining the meaning of life and social adaptability. During the nursing process, we used professional knowledge to provide appropriate nursing treatment for the client, but there was still insufficient care and intervention of spirit. We recommend an improved continuing education program related to spirit intervention to enhance the communication ability of nursing staff. This experience provides nurses with a reference for caring for similar patients and improving quality care, so that they can achieve body-mind-soul care.