一位幼兒期初罹患急性淋巴性白血病的照護經驗

A Nursing Care Experience of a Toddler with Primary Diagnosis of Acute Lymphoblastic Leukemia

本文旨在探討一位初次罹患急性淋巴性白血病幼兒的照護經驗，護理期間自2019年1月29日至2019年2月24日，筆者運用Gordon十一項護理評估、藉由直接照護、觀察、會談等方式蒐集資料，確認護理問題，包括：營養狀況改變-少於身體需要、恐懼及照顧者角色緊張，筆者依個案認知發展及護理問題，設計幼兒期且以家庭為中心之個別性護理，藉由會診營養師、藝術及音樂治療師的專業建議提供個案願意進食且具營養價值之食物，在侵入性治療前後設計治療性遊戲和給予正向獎勵來降低個案的恐懼；案母面對個案因侵入性治療的不適、疼痛及用藥後導致的情緒不穩，擔憂不知如何照顧產生緊張情緒，此時陪伴支持及傾聽案母感受，引導案母說出個案罹癌的心理衝擊，將心中疑慮及擔心表達出來；藉由與案母共同擬定照護計劃，協助提升解決問題的能力，並讓案母抒發自己面臨的角色轉換、體力負荷，傾聽支持案母心理感受，緩和案母「照顧者角色緊張」的情緒。建議舉辦兒童醫療輔導或遊戲治療實作工作坊，以增加兒癌病童可應用性的機會；也可成立親子共讀社團，藉由親子共讀時間可讓住院中照顧者有短暫喘息機會，以創造兒童醫療友善環境。期望藉由此護理經驗分享，提供給未來照護此類病人之參考。

This article aims to explore a nursing experience of a child suffering from acute lymphoblastic leukemia for the first time from January 29 to February 24, 2019. Gordon's 11 Functional Health Patterns Assessment, direct care, observation and interviews were conducted to collect data and identify nursing problems, including: decreased nutritional needs, fear and t role strain of the caregiver. An individual familycentered care plan was designed based on the cognitive development and nursing problems of the client. Professional suggestions were given through consultation with a dietitian and an art∕music therapist to provide nutritional good that the client was willing to receive. Therapeutic games and positive rewards were provided before and after the invasive treatment to reduce the fear. The caregiver was encouraged to express her concerns, worries and psychological impact while facing her child suffering from discomfort, pain and emotional instability due to acute lymphoblastic leukemia. By involving in the caring plan, the mother was able to improve her problem-solving ability, express her stress and physical burden. The nursing professionals listened to the caregiver and eased her role strain. It is recommended that workshops regarding Child Life Service and play therapy can be hold to increase the applicability of children with pediatric cancer. Parent-child reading clubs can also be established for the caregivers in the hospital as a respite care service. By so doing, a medically friendly environment was created. It is hoped that through this sharing of nursing experience, it will provide a reference for caring similar patients in the future.