運用關懷理論於一位初診斷急性骨髓性白血病病人之照護經驗

Nursing Experience in Applying Swanson's Caring on a Patient with Newly Diagnosed Acute Myeloid Leukemia

王尹貞(Yin-Chen Wang)

《馬偕護理雜誌》 14卷1期 (2020/01) Pp. 69-78

https://doi.org/10.29415/JMKN.202001_14(1).0007

摘要

本文為描述一位初次診斷急性骨髓性白血病患者接受化學治療之照護經驗，於2017年6月14日至2017年8月2日照護期間，藉由持續性直接參與照護，觀察、會談、身體評估與醫療團隊討論方式收集資料，以整體性護理評估方式評估個案之生理、心理、社會、靈性各層面，確立個案有潛在危險性損傷／與血小板低下有關、焦慮／與化學治療及副作用不了解有關、體溫過高／與化學治療後血球下降及感染有關之健康問題。運用Swanson關懷理論為照護方針，與個案建立良好護病關係，透過個別性護理活動，運用陪伴、傾聽、同理心，給予正確知識、提供心理情緒支持，使個案減緩焦慮，能夠了解疾病，學習與疾病共存，能夠自我照護，成功因應初次接受化學治療之不適症狀，並能以正向的態度面對後續治療。冀望能與護理人員分享此照護經驗，提供在臨床實務之參考。

關鍵字

急性骨髓性白血病 ； 關懷理論 ； 初次罹癌

並列摘要

This case report describes a nursing care of a patient with newly diagnosed acute myeloid leukemia underwent chemotherapy. From June 14 to August 2 2017, collecting information through continuous direct participation in care, observation, interviews, physical assessment and medical team discussions, with a holistic approach in the care assessment was undertaken. Health related problems were identified including problem of anxiety, risk for bleeding and fever. Applying the five stages of Swanson's Caring (knowing, being, with-doing, for-enabling and maintaining belief) were used. Several strategies were offered to the case-patient included reducing the feeling of anxiety, sustaining the self, developing self-worth, understanding disease, considering new role in the future, learning to coexist with the disease, being able to self-care, succeed in responding to the symptoms of initial chemotherapy, and be positive in the confrontation of illness and treaments. The positive attitude toward confronting with follow-up treatment was reinforced. I hope to use this report to share the experience of caregiving with other nursing staff and to provid as a reference for the clinical practice.

並列關鍵字

acute myeloid leukemia ； Swanson's care theory ； newly diagnosed illness