照顧一位骨肉瘤青少年接受術後輔助化療的護理經驗

Nursing Care Experiences of an Adolescent Boy Receiving Postoperative Adjuvant Chemotherapy for Osteosarcoma

王佳琪(Chia-Cha Wang) ； 王資惠(Tzu-Hui Wang) ； 穆佩芬(Pei-Fan Mu)

《臺大護理雜誌》 15卷1期 (2019/01) Pp. 53-63

https://doi.org/10.6740/NTUHJN.201901_15(1).0006

摘要

本文描述一位十五歲的青少男罹患骨肉瘤之護理經驗，護理期間自2016年5月5日至6月6日，為手術後施打化療的階段。透過實際照護與閱覽病歷等方式收集資料，確立個案有「身體活動障礙」、「身體心像紊亂」與「學校同儕疏離」的健康問題。於身體活動障礙的護理除提供復健衛教外，也透過手機遊戲來協助手指靈活度，更利用重新返回學校的議題來強化個案維持復健的動機；身體心像紊亂方面以同理的態度引導個案分享內心想法，情境演練來協助個案建構因應策略；學校同學方面，鼓勵個案漸進式的參與學校活動，並協助案母與學校溝通，讓學校了解個案的需求以促進同儕間的互動。希望藉由本文統整，提供日後護理人員於臨床參考。建議將手機遊戲納入照護工具以增強青少年復健動力，及正視青少年維持同儕互動之發展需求，加強個人、家庭及學校準備。

關鍵字

青少年 ； 骨肉瘤 ； 活動障礙 ； 身體心像衝擊 ； 同儕疏離

並列摘要

This paper described the nursing care of a 15-year-old adolescent boy with osteosarcoma who underwent the chemotherapy after surgery. The nursing period was from May 5^(th) to June 6^(th), 2016. Data was collected through clincial nursing care and medical record review. After completing nursing assessment, the health problems of impaired physical mobility, body image disturbance, and alienating peers from school were identified. The rehabilitation instruction was offered to improve patient's impaired physical mobility. In addition, the mobile phone games were used to increase finger dexterity. The discussions for school issue reentry also inspire the patient's motivation to maintain rehabilitation. For body image disturbance, we encouraged the patient to share his thoughts and listened with empathy. Also, the similar scenario simulated the patient to construct coping mechanism. For the classmates and the school, we encouraged the patient to gradually participate school activities. We helped the parents discuss patient's conditions with the school to understand the patient's demands and promote the peers interaction. To sum up, this article could provide information for similar clinical experience. We suggest that including mobile games in nursing methods, because it could increase the patient's motivation of rehabilitation. Moreover, knowing teenagers' demands in their life and enhancing the preparation of family and the school are essential.

並列關鍵字

Adolescent ； Osteosarcoma ； impaired physical mobility ； body image disturbance ； alienation from peer