運用關懷照顧概念協助一位腦瘤病童及主要照顧者之護理經驗

An Experience of Using the Concept of Caring a Patient with Brain Tumor and Her Primary Caregiver

當孩童遭遇疾病的威脅而住院治療，隨之而來的疾病痛楚醫療處置及陌生環境對孩童和家屬來說是都是極大的壓力，兒科強調以家庭為中心之照護，而關懷一直被認為是護理的本質和核心，筆者自2011年4月20日至2011年5月20日擔任主要照護護理師，運用關懷照顧的概念協助腦瘤病童及其主要照顧者，藉由與個案觀察、會談及互動以收集資料，同時透過整體性評估來確認個案有潛在危險性感染、活動無耐力及娛樂活動缺失等問題，而主要照顧者有角色緊張的問題，筆者配合關懷照顧概念作為護理過程的指引，設計蓋章、打卡活動及拼圖小卡遊戲排定每日活動內容，讓個案有興趣且主動參與護理過程，主要照顧者部分則是經由共同會談、陪伴、傾聽，確認焦慮來源，提供個別性的護理措施，有效協助個案和案母因應初次診斷腦瘤所面臨的身心困擾，並以正面態度面對後續的治療。期許藉由此次照護經驗的分享提昇臨床護理人員對於孩童需求和心理感受之重視，協助孩童宣洩、調適住院壓力及滿足。

Hospitalization is a tremendous pressure to children and their family. Family-centered care is emphasized by pediatric department, and it’s thought that caring is the essence and the core of nursing. The report described the experience of using the concept of caring in a patient with brain tumor and her primary caregiver. Data was collected by observation, interview, and entire assessment from April, 20 to May, 20 in 2011. The patient’s health problems were identified as risk for infection, activity intolerance, and deficit of diversional activity. The primary caregiver expressed to have role strain during our interviews. We used the concept of caring as a nursing process to engage the patients interest to participate actively in scheduled daily activities by seal design, time clock activities, and jigsaw games. We also identified the source of anxiety of the primary caregiver by interview, accompanying, and listening. We provided individualized intervention to help the patient and the primary caregiver to cope with the initial diagnosis of brain tumors and follow-up treatment with a positive attitude. This experience can serve as a reference in clinical care settings.