運用羅氏適應模式照顧一位惡性骨肉瘤截肢青少年之護理經驗

因癌症導致身體外觀與功能的改變及化學治療過程中產生的副作用，對癌症青少年而言都是極大的打擊及痛苦，若未予協助及妥善處理，將對其生理、心理及社會發展等層面產生不良的影響。本文乃報告一位罹患惡性骨肉瘤青少年於化學治療中，因腫瘤復發，並接受左膝上截肢手術之照護經驗。筆者於92年12月23日至93年2月5日擔任其主護護士，在良好的護病關係中，藉由直接照顧、觀察、會談、傾聽等方式及運用會談過程記錄收集資料，以生理功能、自我概念、角色功能、相互依賴等四種羅氏之概念架構，評估個案之主要護理問題為：1.疼痛2.睡眠型態紊亂3.身體活動功能障礙4.預期性哀傷5.身體心像紊亂等五項。經過護理人員全程照護，並運用相關資源，協助個案與家屬歷經術後恢復期，最後終能建立其正向之身體心像及調適。希冀藉此護理經驗分享，提供給護理同仁作為日後臨床照護之參考。

關鍵字

惡性骨肉瘤；截肢；羅氏適應模式

並列摘要

Both the body appearance and function are altered by cancer itself and the side effects caused by chemotherapy. These adverse effects have a deep impact on the patient, especially from the physiological, psychological and social point of views. This report describes the nursing experience of a post-amputation aldolescent with recurrent osteosarcoma. From December 23, 2003 to February 5, 2004, by using Roy's adaptation model, the author took direct care, observation, clinical interview and listening technique to evaluate the patient's health problems. There were five nursing issues highly concerned: 1. pain. 2. sleep pattern disturbance. 3. impaired physical mobility. 4. anticipatory grieving. 5. body image disturbance. Through comprehensive nursing care, searching supportive resource, assisting the patient and his family to recover the suffering of post-amputation, the author assisted the adolescent getting the positive body image and adaptation. And the patient was encouraged to commence a new life. This case report is good to share with other health care provider in order to improve the quality of nursing care.