一位嗜中性白血球低下之幼兒期兒童照護經驗

本文描述一位嗜中性白血球低下幼兒期男童之護理經驗。照護期間自2019年8月29日至9月7日，運用紐曼系統模式評估，以觀察、訪談及直接照護進行資料收集，確立個案有體溫過高、恐懼及照顧者角色緊張的健康問題。筆者配合幼兒期兒童認知發展，在護理過程中，一、提供個案補充適當水份和維持舒適環境，更換乾淨棉質衣物、溫水拭浴及睪丸傷口照護與監測生命徵象；二、藉由角色扮演及醫生玩具包，提供貼紙、氣球等正增強鼓勵策略，減輕個案恐懼，提升配合醫療措施如：傷口換藥、注射靜脈留置針等；三、經醫療團隊合作運用醫病共享決策及同理心主動關懷案母。建議臨床同仁照顧相似個案可鼓勵照顧者參與個案的生活照護技巧，給予正向回饋及支持，進而提升照顧者信心及生活品質。

關鍵字

嗜中性白血球低下；紐曼系統模式；醫病共享決策

並列摘要

The article described the nursing experience in caring for toddler boy with Neutropenia. Neuman's System Model was used to assess, develop, and evaluate nursing problems and the associated nursing care in relation to the child. Data was collected by observation and interviews, and direct care was undertaken from August 25 to September 7, 2019. Three nursing problems identified included the child's hyperthermia and fear, and the caregiver's role strain. According to the cognitive-developmental theory, firstly we provided the child with adequate amount of fluid intake, tepid-water sponging, the change of clean cotton clothes and regular monitoring of body temperature to maintain normal vital signs. Secondly, we attempted to implement some strategies such as role-playing games, stickers and balloons as rewards…etc. to reduce the child's fear of dressing change, and insertion of peripheral venous catheter…etc. Thirdly, with Shared Decision Making (SDM) adopted by the medical team and showing empathy to the child's mother were carried out throughout the whole nursing process. From the nursing experience, the author hoped to use this report as an exemplar for other healthcare providers when in face of caring for the caregivers with such case. Offering positive feedback and support by encouraging the caregiver to participate in daily nursing care would be particularly crucial because it can help improve the self-confidence and quality of life of the primary caregivers caring for a child with Neutropenia.

並列關鍵字

neutropenia ； Neuman's systems model ； shared decision making

參考文獻

Christian, B. J. (2016). Translational research--Caregiving challenges for parents of children with rare chronic conditions due to genetic disorders. Journal of Pediatric Nursing, 31(1), 99-101. https://doi.org/10.1 016/j.pedn.2015.11.015

Odeya, D., Yariv, F., Ruslan, S., Joseph, K., & Eugene, L. (2018). The infectious and noninfectious etiology, clinical picture and outcome of neutropenia in immunocompetent hospitalized children. The Pediatric Infectious Disease Journal, 37(6), 570-575. https://doi.org/10.1097/inf.0000000000001893

Dale, D. C. (2017). How I manage children with neutropenia. British Journal of Haematology, 178(3), 351-363. https://doi.org/10.1111/bjh.14677

Karlsson, K., Rydstrom, I., Nystrom, M., Enskar, K., & Dalheim Englund, A. C. (2016). Consequences of Needle-Related Medical Procedures: A Hermeneutic Study With Young Children (3-7 Years). Journal of Pediatric Nursing, 31(2), e109-118. https://doi.org/10.1016/j.pedn.2015.09.008

Lin, J., Clark, C., Halpern-Felsher, B., & Sanders, L. (2018). 2240 Shared decision making in child health: A qualitative study of parents of children with medical complexity. Journal of Clinical and Translational Science, 2(S1), 87-87. https://doi.org/10.1017/cts.2018.304

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一位嗜中性白血球低下之幼兒期兒童照護經驗

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