- 期刊
白血病接受骨髓移植後早期復發無望感病人之護理經驗
The Nursing Experience of Caring for a Leukemic Patient with Hopelessness Who Relapsed Early after Hematopoietic Stem Cell Transplantation
摘要
本文係探討一位白血病接受骨髓移植後，疾病早期復發，接受化學治療及回輸幹細胞誘導排斥反應，面對長時間重複化學治療造成的副作用及宣告治療成效欠佳，因此產生無望感之個案，需要護理過程協助關懷維護生、心理及靈性之健康調適。護理期間為2015年6月23日至11月5日，經由觀察、直接會談、身體評估及護理活動紀錄收集資料，確立「現存及伺機性感染」、「營養不足」、「無望感」等主 要健康問題。透過關懷技巧同理病人感受，建立良好且信任的治療關係，引導個案正向思考以強化調適能力；指導工具及資源運用以提升自我照顧認知及技能；建立良好的團隊合作模式，臨床藥師協助加強監測藥物副作用及臨床應用成效，營養師協助維護預防惡病質，社工評估經濟壓力，安寧共照團隊協助評估關懷末期病情告知後之衝擊調適，以成功的建立全人醫療良好成效。建議依專科性質，透過案例討論強化醫護人員對於末期需求評估及介入時機之判斷、處理能力，同時提升共照團隊溝通關懷能力，更有技巧的引導滿足病人及家屬之需求。
並列摘要
This case report shares the nursing experience of caring for a patient who experienced a leukemia relapse early after hematopoietic stem cell transplantation. The patient later received chemotherapy and peripheral blood stem cell reinfusion for graft-versus-host disease induction. After facing long-term, repeated chemotherapy-related side effects and poor treatment response, the patient developed great distress. Such patients urgently need nursing intervention to care for their physical, psychological, and mental health to help them with coping mechanisms. The patient received nursing care from June 23 to November 5, 2015. Through observation, conversation, physical assessment, and nursing activities, some major health problems were identified. The nursing problems included risk of infection, nutrition imbalanced less than body requirements, and hopelessness. To motivate the patient to think positively to strengthen her adaptation ability, we applied caring techniques to develop a sound and trusting relationship with her. We also utilized tools and resources to enhance her self-care awareness and skills. By establishing multidisciplinary teamwork, such as clinical pharmacists for monitoring the side effects and efficacy of medication, nutritionists for helping with cachexia prevention, social workers for an economic pressures assessment, and a hospice shared caring team for the evaluation of adjustment to psychological trauma after diagnostic disclosure, we can provide patients with effective holistic medicine. Through a case discussion, the ability to evaluate the need and discern a proper intervention for health care providers will be enhanced. The case discussion also promotes the communication skills of the team. As a result, healthcare practitioners can more efficiently satisfy the medical needs of patients and their families.