運用羅氏理論照護一位初次診斷急性骨髓性白血病個案之護理經驗

A Caring Experience of A Patient Initially Diagnosed as Acute Myeloid Leukemia Based on Roy's Adaptation Model

本文為照護一位38歲女性初次診斷急性骨髓性白血病接受治療的護理照護經驗。護理期間自2020年07月04日至2020年7月20日共17天，筆者運用羅氏護理評估，藉由身體評估、持續性照護、會談、觀察，收集主客觀資料，確立個案護理問題：保護能力改變、高危險性出血、不確定感等健康問題。因疾病與化學治療引起保護能力改變及高危險性出血，除給予輸血治療外，錄製護理指導影片提供翻轉式學習，於個案觀看影片後進行討論與評值，針對不了解處加強指導，以提升自我照護能力。確診後個案感受到疾病及治療預後造成的不確定感，藉由傾聽、陪伴、同理及跨團隊的病情討論會議，提升個案對疾病的認知與後續治療方針及計畫，同時安排關懷師給予關心、病友團體經驗分享與支持，配合個案的宗教信仰寄託、音樂放鬆療法，協助個案調適身心的痛苦及壓力，降低個案對無法預期的疾病進展與預後所產生的不安，使個案能以正向態度面對疾病及療程。目前衛教教材以單張為主，建議未來可發展與疾病相關的衛教影片，讓個案反覆觀看並輔助衛教翻轉學習，提升學習動機與成效，降低個案及照顧者面對病程變化，及治療衍生的照護問題所產生的壓力。

This study aims to share a caring experience of is a 38-year-old female patient initially diagnosed as acute myeloid leukemia from July 4 to July 20, 2020. Data were collected by physical assessment, continuous care, interviews and observation based on Roy's adaptation model. The major health problems were (1) changes in self-protection ability, (2) high-risk bleeding and (3) sense of uncertainty. Blood transfusion was conducted due to the changes in protective ability and high-risk bleeding caused by the diseases and chemotherapy. In addition, a nursing instruction video was provided to the patient in terms of flipped learning. Discussions and appraisals were conducted to enhance the self-caring ability of the patient. To relieve the sense of uncertainty of efficacy, listening, accompanying, empathy and transdisciplinary meetings were provided, so she was able to understand the following treatment plans. Spiritual caregivers, supporting groups, religious and music interventions were arranged to reduce the pain, stress and anxiety while facing the unexpected disease prognosis. It is suggested that videos on health education of the disease can be developed to improve the learning motivation and effectiveness; also, to reduce the stress of the patient and caregivers while facing disease changes and caring problems.