應用復原力理論照護一位白血病青少年之護理經驗

Nursing Experience of Caring for a Teenager with Leukemia: Application of the Resilience Theory

10.6880/TJON.202212_22(2).05

林雅卿(Ya-Ching Lin)；洪兆嘉(Chao-Chia Hung)

青少年 ； 復原力 ； 白血病 ； 肥胖 ； 護理 ； Adolescents ； resilience ； leukemia ； obese ； nursing

腫瘤護理雜誌

22卷2期（2022 / 12 / 01）

65 - 75

英文

本文主要在描述一位15歲罹患白血病的肥胖青少年，父母離異，最後一次化療2019年10月20日至11月22日期間的護理經驗。藉由直接照護、觀察、會談及查閱病歷等方式收集相關資料，運用生、心、社會、靈性綜合性評估，歸納分析個案主要的護理問題有：營養不均衡／與缺乏正確飲食行為有關；重返校園及社會之焦慮／與缺乏控制感有關。筆者以復原力的理論為依據，提升健康促進的認知技能，鼓勵正向思考，協助建立支持網絡以增進病童適應。首先，提供個案正確健康飲食的知識，一起討論個別化飲食備置的技巧，護理過程融入個案喜愛的手機活動，以手機APP記錄及備忘錄提醒用餐及食物類別，與個案父母親討論營養支持的重要性，使個案能逐步採行健康的飲食行為。其次，傾聽並接納其感受，鼓勵正向思考，提供個案化療相關知識及協助促進舒適，鼓勵應用手機設定提醒健康生活常規，和個案父母親溝通說明病童想法及需求，使個案能主動應付疾病所造成的生活改變。希望藉由此案例分享，提供護理人員了解白血病青少年的護理需求及復原力理論的應用，以提升罹患癌症青少年的照護品質。

This article describes the nursing care experience of a 15-year-old obese adolescent with leukemia during the last chemotherapy. Nursing care was administered from October 20 to November 22 2019. Data were collected through direct care, observation, patient interviews and medical records. Comprehensive assessments of the physical, psychological, social, and spiritual realms were done. The main health problems identified were: 1. nutritional imbalance, related to the lack of sound dietary behavior, and 2. anxiety of returning to school and society, related to lack of control. Based on the theory of resilience, the author enhanced the cognitive skills for health promotion, encouraged positive thinking, and helped to establish the support networks to improve the social adaptation of the patient. Firstly, by providing the correct knowledge of healthy diet, the author introduced the individualized diet preparation skills. The nursing process integrated the patient's favorite mobile phone activities with APP as the meal and food types reminder. Patient's parents were also made aware of the importance of nutrition support plan and participated so that the patient was able to adapt to the healthy diet behavior gradually. Secondly, listening to and accepting his feelings, encouraging positive thinking, and teaching chemotherapy related knowledge and comfort promotion methods were also integral parts of the care process. With the use of mobile phone setting to remind the patient of a healthy life style, plus the parents' communication with the patient about his opinion and needs, the patient was able to actively cope with the life changes caused by the disease. It is hoped that this case report can clarify the needs of adolescents with leukemia and share the theory of resilience with nurses so as to improve the quality of care for adolescents with cancer.

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