一位神經母細胞瘤兒童接受臍帶血移植之照護經驗

Nursing Experiences of a Child with Neuroblastoma Receiving Umilical Cord Blood Transplantation

10.3966/168395442014061401008

劉佩俞(Pei-Yu Liu)；謝麗鳳(Li-Feng Hsieh)；陳美碧(Mei-Bih Chen)

神經母細胞瘤 ； 臍帶血移植 ； 焦慮 ； 照顧者角色緊張 ； neuroblastoma ； umbilical cord blood transplantation ； anxiety ； caregiver role strain

腫瘤護理雜誌

14卷1期（2014 / 06 / 01）

93 - 102

繁體中文

本文探討一位神經母細胞瘤復發之學齡期兒童於骨髓移植中心接受臍帶血移植治療的護理經驗。筆者於2012年12月3日至19日運用Gordon十一項功能性健康型態為評估工具，經由觀察、傾聽、溝通、身體評估、病歷紀錄等方式收集資料，而確立個案健康問題；因文章篇幅限制，僅摘錄焦慮、照顧者角色緊張、口腔黏膜改變等重要問題呈述。因骨髓移植中心是一個保護性隔離的環境，為了減少感染的機會，主要照顧者無法進入病室陪伴，導致個案出現分離焦慮、照顧者角色緊張的問題。經由護理人員親切、接納的態度，持續關懷及適時陪伴，建立信任的護病關係，並根據學齡期兒童身心發展特質，使用適當的溝通技巧，以畫圖說故事和遊戲的溝通方式，提供口腔護理衛教來加速口腔潰瘍癒合。期望藉此護理經驗分享，提供未來臨床護理人員照顧此類病童之參考指引。

This article described the nursing care processes of a school-age child with recurrent neuroblastoma receiving umbilical cord blood transplantation at the bone marrow transplant center. The author applied Gordon's functional health patterns as an assessment tool to collect data through observation, listening, communication, physical examination and chart review to identify the child's problems from December 3 to December 19 in 2012. Because of the page limitation of this article, the health problems extracted were only the extant anxiety, caregiver role strain, and oral mucosa change. Bone marrow transplant center provided a protective isolation sterile environment. In order to reduce the chance of infection, primary caregiver was not allowed to enter the ward. This had resulted in the child's suffering from separation anxiety, and primary caregiver's alteration in playing her/hisroles. This report showed that the nurses' kind and acceptable attitude, together with the continuing care and timely accompanyinghad built up mutual trust relationship between the nurse and the child. In addition, the nurse used appropriate communication skills, role playing and storytelling with paintaccording to the physical and mental developmental characteristics of the school-age children to provide them oral health care skills to enhance the healing of oral ulcer. We hope that the nursing experiences in this article can serve as a reference, and guide clinical nursing staff how to take care of pediatric patients receiving blood transplantation.