一位腦部髓母細胞瘤兒童接受自體幹細胞移植之照護經驗

Nursing Experiences of a Child with Medulloblastoma in the Brain Receiving Autologous Hematopoietic Stem Cell Transplantation

10.6880/TJON.202106_21(1).08

陳厚君(Hou-Chun Chen)；侯宥如(You-Ru Hou)

髓母細胞瘤 ； 自體幹細胞移植 ； 無效保護能力改變 ； 知識增進準備度 ； 身體心像紊亂 ； medulloblastoma ； autologous stem cell transplantation ； Ineffective protection ； Readiness for enhanced knowledge ； disturbance body image

腫瘤護理雜誌

21卷1期（2021 / 06 / 01）

87 - 98

繁體中文

本文探討一位腦部髓母細胞瘤，合併頸椎和胸椎轉移致雙下肢癱瘓之九歲病童，於自體幹細胞移植過程中，拒絕照護及學習相關照護技能之護理經驗。筆者於2017年11月10日至11月25月運用Gordon十一項健康功能型態為評估工具，透過傾聽、直接觀察、會談、身體評估及病歷查閱等收集資料，確立個案健康問題為無效保護能力改變、知識增進準備度、營養不均衡及身體心像紊亂。病童因外觀及身體缺陷，缺乏自信，筆者依其發展階段，建立良好護病關係，依其喜好，以遊戲（左一拳，右一拳、黑白猜及海帶拳）、食物圖畫卡組合點餐及播放衛教、勵志影片（微電影－跳舞吧！機器人）等措施，增加參予照護意願、提高保護性隔離措施及移植後居家照護配合度，鼓勵表達情緒及同儕互動，增加其正向支持系統。盼此次照護經驗能提供臨床護理人員照護類似病童之參考。

This article discusses a 9-years-old child who has medulloblastoma in her brain combined with cervical and thoracic spine metastasis which caused paraplegia. Patient refused care and refused to learn the self-care skills during the autologous stem cell transplantation. The nursing period was from November 10 to November 25 in 2017. The Gordon 11 Function Health Patterns was applied to collect patient's data through listening, observation, communication, physical examination, and chart review. Four major health problems identified were ineffective protection, lack in readiness for enhanced knowledge, imbalanced nutrition, and body image disturbance. The child's lack of confidence is due to her appearance and physical deficiency. For this stage of care development, the author first established a good nurse-patient rapport, she then included children's hand games (e.g. Guess with both hands, Rock-paper-scissors and Seaweed game), the game of food ordering with the card of foods and drinks, educational videos and inspirational movies (e.g. Microfilm = My very first Dance!) in the nursing care, in order to increase the patient participation in self-care. Author also promoted the intervention of protective isolation and the home care of post stem cell transplantation, encouraged the expression of emotions and peer interaction to increase her positive support system. To sum up, this nursing care experience can serve as a reference for clinical nurses who care for pediatric patients in similar conditions.

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