一名白血病青少女身體心像改變及因應之探討

To Explore the Body Image Changes and Coping Strategies of an Adolescent Cancer Patient

在台灣兒童癌症中以血癌發生率最高，約佔所有兒童癌症的37%，而青春期是對自我身體心像是否滿意的重要時刻，因癌症本身及相關治療引發的負作用將會衝擊青少年身體心像的發展，故探討青少年因癌症影響身體心像的經驗乃不容忽視。本報告乃在探討一名青少女罹患白血病及接受化學治療後，經歷身體心像改變及因應的心路歷程。筆者將與個案互動過程書寫成行為過程記錄，運用內容分析法分析會談內容。結果分成身體心像的改變及因應策略兩大部分。身體心像的改變包括身體結構的改變、身體功能的受損、身體感覺的改變及社會功能的改變；因應策略包括掩飾性、情緒發洩、學習承擔自我照護及尋求支持的因應策略，經由個案個人的努力調適，加上家人及醫療人員的協助下，可以主動與其他病友互動及詢問相關的訊息，也可逐漸接受自己身體心像的改變並承擔自我的照護活動。護理人員於護理過程中傾聽、陪伴、同理及接受青少年的態度相當重要，並應將同儕及家人納入照護計劃中，適時提出青少年個人的優點，使個案接受自己及重建已被破壞的身體心像。

The incidence of leukemia is the highest among all childhood and adolescent cancers in Taiwan, representing about 37% of total cancers. Body image is an important element of teenagers. Cancer per se and the side effects of cancer treatments can negatively impact the development of body image of adolescent patients. Therefore, it is important to explore the impact of cancer on the body image of the adolescent. This case report described an adolescent girl who experienced body image changes due to leukemia and the related chemotherapy treatments and adopted coping strategies. The data were collected by process recording and analyzed by the content analysis method. The findings included two parts in terms of body image changes and coping strategies. Body image changes included physical structural change, body function impairment, body sensation change, and social function change. Coping strategies included covering, emotional outlets, learning self-care skills, and searching for support. Through the efforts by the patient, her family members, and health professionals, the patient was not only able to talk to other hospitalized children and request for information actively, but also gradually accepted her changed body image and took over caring activities herself. It is important that nurses provide the adolescent suffering from cancer with support, such as listening, empathy, acceptance, and companionship. Family members and their peers should also be included in the nursing care plan. Nurses should encourage adolescents recognize their advantages to help them re-build their body image.