運用生態系統理論於一位學齡期氣喘兒童之護理經驗

Nursing Care of a School-Age Child wth Asthma: An Ecological System Theory Approach

本文運用Bronfenbrenner於1979年提出之生態系統理論，評估環繞於一位學齡期氣喘兒童的生態環境，分析對其發展過程的影響。護理期間為2010年3月16至4月16日，藉由臨床照護、門診追蹤、電話訪問、家庭訪問及學校訪問進行資料收集、評估及分析。結果顯示與這位氣喘學童最直接相關的微系統生態環境為家庭成員、住家環境、校園環境、學校護理人員、老師、同儕、體育活動與醫護人員。中系統為父母、學校護理人員、老師及同儕不瞭解氣喘病及照護方式，環境中潛藏氣喘誘發因子，使病童未獲得適當醫療照護之協助。外系統可瞭解該家庭社會經濟資源充足，父親因工作時間彈性可全責照護病童，獲得政府「氣喘醫療給付改善方案」之支持。大系統中瞭解到父母的氣喘治療與照護觀念受風俗文化影響，拒絕西醫而選擇中醫三伏貼治療。經由生態發展理論評估後，發現病童與生態環境的關係乃以家庭及學校關係為基礎，分別針對病童、父母與學校規劃適當的氣喘管理照護計畫及措施。成效可見，病童與父母共同努力學習氣喘照護後，使氣喘症狀獲得控制。

This research applied the Ecological System Theory of Dr. Bronfenbrenner (1979) to evaluate and analyze the impact of a school-age asthmatic child's ecological environment on the child's development. This project ran from March 16th to April 16th, 2010. A full range of data was collected during clinical care, outpatient follow-up services, telephone interviews, home visits, and school visits and then identified and analyzed. Results indicated that the family, household environment, campus, teachers, classmates, physical education program, and medical staffs comprised the most immediate microsystem and that parents, school nurses, teachers, and classmates formed the child'smesosystem. Researchers found a lack of understanding and appreciation in the mesosystem regarding asthmatic patient care needs. Hidden factors in the environment induced asthma, which eventually caused the child to be unable to obtain necessary medical care assistance. The exosystem reflected adequacy of the family social economy. The father's flexible working hours allowed him to allocate more time to childcare responsibilities. The government Asthma Medical Payment program also facilitated effective care. The macrosystem demonstrated parental cognition related to asthma treatment and caring to be deeply influenced by local customs. Thus, rather than using advanced medical treatments, parents preferred to follow traditional Chinese medicinal practices. Evaluation using the Ecological of Human Development Theory showed the subject's ecology environment relationships as based upon a foundation of family and school. Therefore, active family and school support for an asthma management plan appropriate to the subject's needs was critical. Asthma symptoms were better controlled after the child and his parents invested greater effort in mastering asthma management protocols.