一位重度智能障病人接受異體幹細胞移植之照護經驗

Caring for a Patient with Severe Intellectual Disability during Allogeneic Hematopoietic Stem Cell Transplantation

10.6880/TJON.202006_20(1).08

吳佩琪(Pei-Chi Wu)；葉家鈴(Chia-Ling Yeh)；侯宥如(Hou-You Ru)

智能障礙 ； 異體幹細胞移植 ； 分離焦慮 ； intellectual disability ； allogeneic hematopoietic stem cell transplantation ； separation anxiety

腫瘤護理雜誌

20卷1期（2020 / 06 / 01）

97 - 111

繁體中文

本文描述一位重度智能障礙者接受異體幹細胞移植後，護理人員協助個案及中度智能障礙之主要照顧者（雙親），學習幹細胞移植後居家照護的護理經驗。2017年3月23日至2017年4月10日之照護期間，筆者運用Gordon十一項健康功能型態進行評估，透過病歷查閱、觀察、會談、直接護理等方式收集資料，確立個案的健康問題有：無效性保護能力／全血球低下、營養不均衡／少於身體需要、家庭因應能力準備度／異體幹細胞移植後的居家照護、分離焦慮／與家人分開。期間配合個案的認知發展，運用繪圖、遊戲、覆誦、影音錄製、集點卡蓋章獲得獎品等策略，協助個案學習幹細胞移植後的照護，運用通訊軟體、家庭照片、個案有興趣的事物，如唱歌、玩扮家家酒等，降低個案與家人分離焦慮的情緒反應。評估家庭結構及主要照顧者的理解程度，以按表操課方式如：制定表格勾選，再由其他家庭成員檢視正確性並補齊其不足之處。透過無縫接軌之照護模式，在個案出院後仍維持相同的照護品質，且順利度過移植後的危險期。期盼藉此經驗分享，作為護理人員日後照護此類病人參考。

This article describes the nursing experience for a patient with severe intellectual disability who was receiving allogeneic hematopoietic stem cell transplantation. The patient's main caregivers (the parents) also have moderate intellectual disability. Therefore, they had trouble learning post-transplant domiciliary care skills. The author utilized Gordon's Functional Health Patterns to evaluate the data collected thorough medical record review, observation, interview, direct care and so on during the nursing period from March 23 to April 10 in 2017. The following health problems were identified: ineffective protection leading to pancytopenia, malnutrition, ineptness in enhanced family coping/domiciliary care after allogeneic hematopoietic stem cell transplantation, and separation anxiety. Considering the patient’s limited cognitive capability, we helped the patient learn post-transplantation caring skills by means of drawing, game, recitation, videos, and rewards card strategy. Moreover, we managed to lessen her separation anxiety with the aid of communication software, family photos, and activities that can arouse the patient's interest such as singing, playing house and so on. Last but not least, we evaluated the structure of her family and their comprehension level and formulated a scheduled class for them to assure proper understanding of caring skills. For example, we designed a questionnaire on which one of the family members circled out the exact statements for the caring skills they had learned; the others checked the correctness and made additional remarks. Thereby the quality of care could still be maintained through seamless handover after discharge, and thus the patient would be over the hump in the post-transplantation period. By sharing the nursing experience described herein, the author anticipates to establish a reference for other nursing staff caring for patients of similar nature.

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