一位白血病併週邊神經病變兒童及其家庭之照護經驗

Nursing Experience in Caring for a Family of a School-Age Child with Leukemia Combined with Peripheral Neuropathy

楊雅汝(Ya-Ru Yang) ； 劉秀美(Hsiu-Mei Liu) ； 呂明蕙(Ming-Huei Lu)

《馬偕護理雜誌》 14卷2期 (2020/07) Pp. 81-91

https://doi.org/10.29415/JMKN.202007_14(2).0008

摘要

本文描述一位性淋巴性白血病復發的8歲病人，因為化學治療導致週邊神經病變的護理過程。病人面對疾病治療過程，造成無法行走、恐懼及家庭運作過程改變等情形，故引發筆者的動機。護理期間自2017年9月13日至10月15日，筆者以觀察、會談、身體評估等方式收集資料，依據Gordon十一項功能性健康型態進行整體性評估，確立健康問題有：活動肌肉無耐力／化療導致的週邊神經毒性、恐懼／反覆的侵入性治療、家庭運作過程改變／疾病造成家庭關係改變。筆者藉由關懷、陪伴、支持以建立關係，協助病人及主要照顧者共同擬定護理計劃，提供個別性的照護，包括：以治療性遊戲方式教導病人、鼓勵主要照顧者表達感受、陪伴主要照顧者、尋求資源及相關支持系統。建議未來可增進兒科護理人員治療性遊戲專業能力或介入跨領域團隊照護。希望藉由分享此照護經驗，能提供類似病人更完善的照護之參考。

關鍵字

化學治療 ； 週邊神經病變 ； 學齡期兒童

並列摘要

The study described the process of nursing in caring for an eight-year-old patient with acute lymphoblastic leukemia who developed peripheral neuropathy as the result of receiving chemotherapy. The medical treatments resulted in the patient disabled in mobilizing, living with fear, and changes in family dynamics, which led to the motivation of writing-up by the author. During the period from September 13, 2017 to October 15, 2017, the author collected data through observation, interviews, physical assessment and performed a holistic assessment on the patient by using Gordon's 11 functional health patterns. The patient's health problems were determined as follows: a lack of muscular endurance/peripheral neurotoxicity caused by chemotherapy, fear/invasive treatment, and change of family dynamics/change of relationship between family members caused by the disease. The researcher established a relationship with the patient by expressing caring and providing companionship and support, helping the patient and the main caregiver to collectively formulate nursing plans. Therefore, individualized nursing care was provided, including using game-based therapy to provide care instructions, encouraging the main caregiver to express feelings, accompanying the main caregiver, and searching for resources and relevant support systems. The study recommended that pediatric nurses can strengthen their professional skills in using game-based therapy or providing care based on a multidisciplinary team approach. The nursing experience is expected to serve as a reference for developing comprehensive nursing care.

並列關鍵字

chemotherapy ； peripheral neuropathy ； school-age child