一位年輕父職罹患多發性骨髓瘤合併洗腎並接受自體幹細胞移植之護理經驗

本文為照護一位37歲患有多發性骨髓瘤且因疾病進展需洗腎並行自體幹細胞移植之護理經驗。因病人於青壯年罹癌、同時具有父親角色的身分，治療過程不如預期的經過引發許多心理層面的問題。癌症病人心理社會問題與病人生活品質息息相關，且年輕父職角色罹癌的相關研究有限，故引發作者選案理由及寫作動機。護理期間為2022年8月5日至8月19日，照顧期間透過Gordon十一項健康功能型態評估，確認主要的健康問題依序為潛在性感染、因應能力失調、焦慮，另有潛在危險性傷害、潛在性營養少於需要、口腔黏膜改變、腹瀉等健康問題，透過提供保護性隔離之護理措施預防移植後感染、協助病人學習有效方法因應情緒困擾、提供完善的後續照護資訊及衛教以減輕移植後返家照護的焦慮，迎向出院後的新生活。有別於老人及兒童族群，青壯年癌症病人族群的照護有其獨特性。此外，有別於母職角色，在父職角色罹患癌症的相關研究較少，對於此族群病人心理的擔憂與問題、及對家庭結構的影響認知之甚少，筆者期待藉此個案照護經驗，能提供護理實務上的參考及方向，未來在臨床照護中對於青壯年且為父親角色之病人能提供更適切的護理。

This case report addresses the author’s experience providing nursing care to a 37-year-old patient diagnosed with multiple myeloma requiring regular renal dialysis due to disease progression who received autologous stem cell transplantation. The patient was diagnosed with cancer in young adulthood and, as a father figure, faced various psychological issues associated with the unexpected challenges encountered during their treatment phase. Psychosocial health, which is closely associated with quality of life in patients with cancer, has gained increasing attention in recent years. The limited research published on the subject of fathers diagnosed with cancer encouraged the author to detail her experience with this case. The care period was from August 5th to August 19th, 2022. During the care period, the Gordons's 11 functional health assessment was applied, with potentially severe infections, coping disorders, anxiety, potential risk of injury existing or potential nutritional deficiencies, oral mucosal changes, and diarrhea identified as the primary health problems of concern. Nursing interventions applied included providing protective isolation measures to prevent post-transplant infection, helping the patient learn effective ways to cope with emotional distress, and providing comprehensive follow-up care information and health education to alleviate the anxiety associated with hospital discharge and life after discharge. The challenges of providing nursing care to adolescent and young adult patients differ significantly from those faced in the care of either elderly or pediatric patients. Furthermore, although extensive research has been conducted on mothers diagnosed with cancer, little research has addressed the impact on the paternal role when fathers are diagnosed with cancer, with limited information available regarding their psychological concerns and issues or the impact on family dynamics. The author hopes this case care experience offers an insightful reference and guide for nursing practice that contributes to a better understanding of the psychological aspects of young adult fathers diagnosed with cancer and facilitates more appropriate care in clinical settings.