一位急性骨髓性白血病患者接受幹細胞移植之護理經驗

Nursing a Person with Acute Myeloid Leukemia Undergoing Stem Cell Transplantation

幹細胞移植替癌症血液疾患者帶來希望與生機，但決定移植及治療過程使病患身心承受的壓力，足以衝擊對生命態度及價值觀；本文探討一位急性骨髓白血病患接受幹細胞移植過程中面臨生理變化、治療隔離及死亡的不確定，藉由整體評估收集資料，運用羅氏適應模式，確立主要有體溫過高、口腔粘膜障礙、身體心像紊亂與焦慮等健康問題，護理過程主動關懷，提供專業減輕治療合併症的不適，運用溝通技巧引導個案心理調適，接受外觀改變事實，進而參與學習自我與居家照顧，達到平衡的健康適應；藉此照護經驗分享，冀護理同仁面對相關移植個案，更重視生心靈層面的需要，達完整照護品質。

Though stem cell transplantation has brought hope of life to cancer patients, the pressure they may suffer physically and mentally during the process of deciding to receive the transplantation and during the treatment itself can result in conflicting and dramatic impacts on their attitudes and values toward life. This article investigates an acute myeloid leukemia patient who confronted physiological changes, isolated treatment and the possibility of death during the process of stem cell transplantation. In addition to data collection and the global evaluation of the treatment process, Roy's adaptation model was also used to determine the patient's health problems, including high fever, mucous membrane ulcers in the oral cavity, body image disorder, anxiety, and so on. During the nursing process, active caring and professional nursing expertise were provided to alleviate the patient's discomfort from complications from treatment. Appropriate communication techniques were used to guide the client to adjust mentally and accept the fact of physical transformation. Furthermore, there is hope that the client can participate in taking care of self at home so as to achieve a balanced and healthy adaptation. Sharing this experience, we hope our nursing colleagues can, when facing transplant recipients, pay more attention to patient's physical, spiritual and mental needs so as to achieve a holistic quality of care.