一位成年期初診斷再生不良性貧血病人之護理經驗

Nursing experience of caring for an adult patient with an initial diagnosis of aplastic anemia

本文是描述一位病人正值成年壯年期卻突然罹患再生不良性貧血，面臨初診斷與治療之身心煎熬，以及接連而來各種情緒困擾之護理照顧經驗。護理期間自2018年6月5日至7月5日，透過直接照護、觀察、會談等方式收集資料，以Gordon十一項健康功能型態進行評估，確認病人有無效性保護能力及情緒困擾共兩個主要健康問題。護理過程，教導病人預防出血方法，鼓勵採床上盥洗、用餐等日常節省能量活動，以及穿著寬鬆衣褲、維持充足睡眠等方法，減少細胞代謝和氧氣需求，另衛教感染徵象及症狀，鼓勵勤洗手、戴口罩及減少訪客等保護性措施以改善生理問題；主動關心、同理及教導緩解情緒困擾的方法，另結合跨領域團隊人員提供疾病相關資訊及需求，共同改善病人情緒困擾問題，讓成年期親密關係發展順利並重新恢復生活意義。建議中央或病房在職教育安排再生不良性貧血及心理照護相關課程，同時邀請血液腫瘤科專家分享骨髓移植照顧經驗，以及跨領域團隊資源運作方式，讓病人得到醫療團隊的最佳效益，藉以提升醫院服務品質。

"This article described the nursing and caring experience of a patient suffering from the physical and mental torture and the subsequent emotional disturbance after the initial diagnosis of aplastic anemia in the prime of his life and while receiving the treatment. The nursing period was from June 5 to July 5, 2018. The materials were collected by direct nursing, observation, and interviews. Gordon 11 Function Health Patterns was adopted for evaluation, and it was confirmed that the patient had two major health problems, ineffective protective capability and emotional disturbance. During the nursing process, the researcher taught the patient the method of bleeding prevention and encouraged the patient to freshen up and eat meals on the bed to conserve energy. The patient was also encouraged to wear loose and comfortable clothes and maintain a sufficient amount of sleep to reduce cell metabolism and oxygen demands. Moreover, health education, including signs of infection, related symptoms, and protective measures, such as frequent hand wash, mask wearing, and reducing the number of visitors, was offered in order to improve the patient’s physiological problems. While actively caring and empathizing with the patient, the researcher also taught the patient the methods to ease emotional disturbance. Combined with relevant information and requirements of the disease provided by the personnel of an interdisciplinary team, the patient’s emotional disturbance was improved; the patient was able to develop adulthood intimacy successfully and regain the meaning of life. For improvement, the researcher suggests to arrange hospital-wise or ward-based in-service education on aplastic anemia care and mental care, invite hematologists and oncologists to share care experience on patients with bone marrow transplant and develop an operation procedure for a cross-disciplinary team. By doing so, patients may receive the optimal benefits from the medical team, and the service quality of the hospital can be improved."