運用紐曼模式於幼兒期癌症復發病童之護理經驗

Case Study: Nursing Experience of a Toddler with Cancer Recurrence using Neuman's System Model

凃辜馨儀(Hsin-Yi Tu Ku) ； 蔡榮美(Jung-Mei Tsai) ； 吳妙(Miao Wu)

《馬偕護理雜誌》 11卷1期 (2017/01) Pp. 92-102

https://doi.org/10.29415/JMKN.201701_11(1).0008

摘要

本文旨在探討一位1歲6個月幼兒期罹患急性骨髓性白血病病童，於癌症復發後，因接受多次侵入性治療，個案出現分離焦慮、失去控制力及疼痛感等負面行為，及主要照顧者面臨幼兒癌症復發產生衝擊的護理經驗。護理期間自2015年3月1日至3月20日，運用紐曼理論進行評估，並以觀察、會談等方式收集資料，確立健康問題有「恐懼」、「照顧者角色緊張」及「家庭運作過程改變」。藉由護理人員進行個別性照護並協助個案及主要照顧者共同擬定護理計劃，包括：鼓勵主要照顧者描述內心感受性、共同陪伴治療過程、多次進行治療性遊戲，期望減輕個案對治療的恐懼，及使家庭了解、釐清所面臨的問題，並共同擬定護理目標，以提供個案之個體內、個體間以及個體外的照護措施，並與個案及主要照顧者面對疾病復發治療過程與心理調適，在壓力的環境產生防禦機制，讓幼兒期個案於住院及家庭環境中維持功能穩定性，降低壓力源及增進整體平衡狀態，幫助家庭獲得良好的調適。期望藉此護理經驗能鼓勵護理人員在幼兒期照護多以病童及主要照顧者角度思考及關懷，提供個別化的關懷護理照護，提升護理照護品質之參考。

關鍵字

紐曼模式 ； 幼兒期 ； 癌症復發

並列摘要

This case study explored the nursing process caring for an 18-month toddler with cancer recurrence of acute myelogenous leukemia. The patient underwent invasive treatments and exhibited negative behaviors of separation anxiety, pain and poor treatment compliance; primary caregivers experienced the impacts of cancer recurrence. Neuman's System Model was used to assess, develop, and evaluate issues and solutions in nursing care. Data collected through interviews and observations during the period of 1-20 March 2015. Care issues including anxiety, caregiver role tension and changes of family function were identified. Nursing staff initiated the protocol of case study and assisted the patient and caregivers to develop nursing plan, in which encouraged caregivers explicit about their inner feelings and showing company during treatments, engaged therapeutic games in respect to reduce fear of treatment for the patient and to clarify questions for family members, and established mutual nursing goals. Nursing measures were devised to provide intra-, inter- and extra-personal care for the patient and caregivers alike in the face of cancer recurrence and treatment procedures to adjust and build defense lines under the stressful environment. The results of these measures allowed the toddler maintaining functional stability both in hospital and at home by reducing sources of stressors and increasing overall equilibrium and helped family members to well adjust under the circumstances. This case study exemplifies that nurses involved caring toddlers could provide multifaceted nursing care from the perspective of their patients and caregivers in order to promote quality of nursing care.

並列關鍵字

Neuman's System Model ； toddler ； cancer recurrence