高中教師團隊合作支持骨癌學生返校的經驗

For a Life Worth a Thousand Pieces of Gold: Teachers’Collaborative Advocacy Teamwork for a Student Returning to High School After Limb-Salvage Surgery for Osteosarcoma

本現象學研究從教師觀點出發，描述高中教師自動自發組成團隊，支持一位罹患骨癌並接受肢體重建手術的學生發展自我倡議能力的教學實踐經驗。該生於高一暑假接受手術，高二返校後以輪椅代步。教師團隊以學生為中心，透過合作與問題導向方式，持續回應學生需求，並逐步轉化教學與支持策略。研究採主題分析法，歸納出教師在合作歷程中四項轉變：一、對學生及其家庭的深度理解是團隊支持學生倡議的基礎。教師主動與醫師、家長聯繫，並細緻觀察學生行為及理解其想法，建立對學生全面的認識。二、從為學生倡議轉向培養其自我倡議能力。教師起初因對學生生命的擔憂而代為發聲，後意識到唯有讓學生學習說出自己的心聲，方能助其真正獨立。三、在支持學生的過程中，也反受到學生激勵。教師原以付出者角色投入，卻在學生進步中獲得認可與成長，亦為癌症倖存者的認輔教師更在此互動過程中得到療癒。四、支持學生自我倡議是團隊工作。導師很快發現為了因應學生需求，必須很「雞婆」，積極尋找不同專業和特質的教師，才能一起有效支持學生成長。另外，團隊成員互相提供情緒支持也是團隊成功因素之一。本研究顯示，支持特殊需求學生的歷程中，教師間的合作與互助不僅促進學生自我倡議能力的發展，也成為教師專業成長與情感支持的來源。有效的團隊運作需有共同目標，並能依學生成長階段而調整目標。合作時，教師不被專業侷限，靈活創造新的角色，方能發揮支持學生的團隊功能，持續推動學生與團隊雙方的發展。

Rationale & Purpose: Teachers play a critical role in facilitating the reintegration of students with cancer into school during or after treatment. Given the relatively low incidence of childhood cancer, teachers might feel unprepared and anxious when they first encounter these students, and this can be attributed to limited knowledge of pediatric oncology and uncertainty regarding effective support strategies. Studies on teachers’attitudes and practices concerning students with cancer have gradually increased, providing valuable insights for researchers and education professionals on how to best serve this population. However, although special education laws, medical and nursing professionals, and academic scholars emphasize the necessity of teamwork and collaboration among hospitals, schools, and homes as well as within the school itself in supporting students with cancer, studies on teachers’experiences have predominantly focused on individual perspectives. In addition, current literature on professional collaboration for students with cancer (and for students with disabilities in general) mainly assigns professionals to distinct roles and responsibilities according to their specialties and professionals tend to consider what they can contribute to the team within the boundaries of their specialized professional knowledge and skills. Collaboration in this predetermined way might be limiting professionals’creativity in developing new roles in a team to meet their individual student’s needs. Accordingly, the purpose of this qualitative study was to address the above gaps and employ a collaborative advocacy framework to describe and understand the year-long experiences of three high school personnel who collaborated as a team to support and advocate for a student with osteosarcoma who returned to school after undergoing limb-salvage surgery. This organic, bottom-up team-building process was intricately linked to the teachers’understanding of their relationships with the student and their perception of their roles in sustaining the student’s physical and emotional well-being. Methods: This phenomenological qualitative study explored a student-centered collaborative advocacy team-building process from the perspectives of teachers. The team comprised a homeroom teacher, a school counselor, and a designated mentor, all of whom supported an 11th-grade student who returned to school after undergoing limb salvage surgery for osteosarcoma. Although the school nurse was also a crucial team member, she opted not to participate in this study. Interviews with the participants were minimally structured, guided by one core question:“Tell me how you interacted with the student.”Throughout the interviews, clarification and follow-up questions were posed to facilitate the recall of event details and sequences and to elicit descriptions of the contexts of their actions and feelings. Each teacher was interviewed individually in a quiet room for 90–180 min. The interview recordings were transcribed verbatim by research assistants and verified by the researcher. The deidentified transcripts were then sent back to the participants for accuracy checks; one teacher confirmed that the transcript required no changes. The researcher analyzed these transcripts by using a three-level thematic coding process, which involved prescriptive coding, interpretive coding, and thematic coding for overarching themes. Four main themes were identified through an iterative interpretive data analysis process. The study protocol was approved by the National Cheng Kung University Human Research Ethics Committee. All participants and the student they worked with provided consent for this study to be conducted and published. Findings: This study employed a collaborative advocacy framework to understand teachers’experiences, and the results revealed four dimensions of dynamic collaborative advocacy: (1) Knowledge as the foundation of advocacy: The teachers proactively sought direct information and cultivated a comprehensive understanding of the student and his family. This in-depth knowledge informed their advocacy efforts, enabling them to provide targeted support where required. (2) From teacher advocacy to student self-advocacy: Initially, the teachers were motivated to advocate for the student to shield him from the challenges of cancer and preserve his well-being. However, they soon recognized the importance of fostering the student’s independence and subsequently shifted their focus to facilitating student self-advocacy. (3) Advocacy as rewarding and healing: The teachers reported feeling rewarded by their work as they witnessed the student’s physical and emotional growth. Notably, one teacher, a childhood cancer survivor, experienced a belated healing process, and he was finally able to confront past traumas and find answers to long-held questions. (4) Advocacy as teamwork: The homeroom teacher soon realized the limitation of her individual advocacy effort and the need for collaboration. She then formed a team with other teachers who shared the same goal of promoting the student’s well-being. Guided by a problem-solving approach, the team members adopted distinct roles to address student needs without task overlap. Based on student needs, team members also created new roles that were beyond their fixed professional job descriptions. Throughout the teaming process, they also expressed appreciation for their colleagues’contributions and provided mutual emotional support. Conclusions/Implications: The study findings extend the literature on team approaches and advocacy regarding teachers’experiences with childhood cancer survivors at school. The researcher argues that comprehensive knowledge about the student, creative and flexible role development of team members, shared goals of student advocacy and self-advocacy, and mutual support among team members contributed to the operation and effectiveness of this collaborative advocacy team. A unique finding of this study is the team’s willingness to transcend conventional professional boundaries, inventing roles and functions to meet the student’s specific needs. For example, the school counselor assumed the role of a public speaking trainer to prepare the student for self-advocacy events. The study findings also suggest that advocacy work and strategies are culturally and situationally dependent. The teachers developed effective advocacy tactics based on their intimate local knowledge of school administrative operations and through consultations with other team members. Regarding self-advocacy instruction for students with special education needs, the findings demonstrate that teaching self-advocacy skills in real-life scenarios, such as guiding the student on how to ask physicians questions and care for his external fixation pin sites, can effectively facilitate student self-advocacy and independence. Limited by regulations governing the identification and placement of students with disabilities, special education teachers were not directly involved in advocating for and supporting the student who was not eligible for special education services upon returning to school. Therefore, this study recommends a more flexible decision-making process that delegates greater authority to schools in determining the eligibility for special education accommodations and services. This would ensure timely support for students in similar circumstances.