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系統識別號 U0026-2308201116195600
論文名稱(中文) 發展學齡期癌症兒童返校醫療照護模式之行動研究--以南部某醫學中心為例
論文名稱(英文) The Action Research to Establish a School Reentry Care Model for School-age Children with Cancer: A Case of Medical Center in Southern Taiwan
校院名稱 成功大學
系所名稱(中) 護理學系碩博士班
系所名稱(英) Department of Nursing
學年度 99
學期 2
出版年 100
研究生(中文) 陳文菁
研究生(英文) Wen-Ching Chen
學號 T26984041
學位類別 碩士
語文別 中文
論文頁數 140頁
口試委員 口試委員-陳建旭
口試委員-徐綺穗
口試委員-蘇英華
指導教授-黃美智
中文關鍵字 學齡期癌症兒童  返校醫療照護模式  行動研究 
英文關鍵字 school-age children with cancer  school reentry care model  action research 
學科別分類
中文摘要 學校是提供學齡期兒童心理社會發展的重要環境,然而疾病與治療對癌症兒童自身、父母與學校所產生的壓力,成了癌症兒童返回學校過程之阻礙,其中醫療單位更為擔負提供癌症兒童返校醫療照護之核心角色,然而目前國內尚無癌症兒童返校醫療照護相關模式可為依循。
經由問卷調查學齡期癌症兒童返校就學情形,並訪談醫護人員返校醫療照護現況與困境,發現醫療單位未能提供具系統化之返校醫療照護,因應癌童返校就學障礙。為此,本研究採行動研究設計,由醫療照護團隊包括主治醫師、護理師、個案管理師、社工師與研究者共同持續進行評估、討論、實際施行之不斷循環的過程擬訂照護模式,而後經專家評鑑及臨床測試後再修訂,發展出符合此醫學中心之學齡期癌症兒童返校醫療照護模式。經由三次團隊會議,確立學齡期癌症兒童返校醫療照護模式包含三個核心目標:返校前準備、建立聯繫管道與返校後追蹤照護。此模式共發展八項照護措施:初診斷家庭會議、出院準備服務會議、返校照護家屬會議、建立與學校老師連繫管道、建立與校護連繫管道、提供返校醫療照護文件資料、建立返校照護評估及追蹤系統,並統整為返校醫療照護流程圖。行動過程藉由與醫療照護團隊成員建立夥伴關係而形成之照護模式,不僅使癌症兒童能獲得系統性持續照護,度過返校適應期而恢復生活正常化,更提昇醫療照護團隊的專業分工與合作功能,為本行動研究之附加成果。
英文摘要 School is an important environment for psychosocial development for school-age children. However, the stress caused by the disease and its treatment influence the cancer children, their parents and the school personnel, which hindered children's school attendance. School reentry care is crucial in continuity care for children with cancer to return their normal daily life. Currently, no comprehensive care model can be followed in Taiwan.
Based on the the results of preliminary investigation in a medical center, there is no systemic school reentry care model for children with cancer. Accordingly, the action research was conducted by physicians, nurses, case manager, social worker and researcher. Through a continual cyclical process of assessment, discussion, practice, evaluation by expert reviewers and clinical testing, the school reentry care model in the medical center was established and revised. After completed three meetings, three aims of school reentry care model for children with cancer were formed, which included 1. preparation before school reentry, 2. establishing a communication channel between the school and the hospital, and 3. following-up after back to school. A total of eight intervention strategies within the three aims were built up, which included: family meeting after receiving the diagnosis, discharge planning meeting, school reentry meeting, establishing contact channels toward the teachers and the school nurse, providing the materials of health care information for school reentry care, establishing the system of evaluation and follow-up, and forming the flowchart of the school reentry care model. This study provided the cancer children a systematic and continuous care model, which assist them to adapt the transient period of normalization.Moreover, under the cyclical process of the action research, the function and cooperation of the health care team members are improved.

論文目次 論文目錄
中文摘要..........I
Abstract..........II
致謝 ..........III
論文目錄..........V
表目錄 ..........VII
圖目錄 ..........VII
附件目錄..........VIII
第一章 緒論..........1
第一節 研究動機及重要性..........1
第二節 研究目的..........4
第三節 研究問題..........4
第四節 名詞解釋..........5
第二章 文獻查證..........6
第一節 學齡期癌症兒童返校正常化之重要性..........6
第二節 影響學齡期癌症兒童返校之相關因素..........7
第三節 癌症兒童返校照護措施與成效相關研究........12
第四節 行動研究..........20
第三章 研究設計..........32
第一節 研究方法選擇......32
第二節 研究場域..........32
第三節 確立研究焦點問題..33
第四節 研究對象選取......41
第五節 研究者背景........41
第六節 實施程序..........42
第七節 研究嚴謹度的檢核..46
第八節 倫理考量..........46
第四章 研究結果..........48
第一節 學齡期癌症兒童返校醫療照護模式的發展與形成......50
第二節 醫療團隊建構學齡期癌症兒童返校照護模式之互動歷程..........101
第五章 討論..........106
第一節 實行返校醫療照護模式引發之改變..........106
第二節 行動過程引發之改變.110
第三節 研究歷程的省思.....113
第四節 延伸臨床問題.......117
第六章 結論與建議.........120
第一節 研究結論...........120
第二節 研究應用...........120
第三節 限制與建議.........122
參考資料 ..................123

表目錄
表2-1 學齡期癌症兒童返校照護計畫相關研究.......13
表3-1 醫療團隊會議議程表.......45
表3-2 行動研究之嚴謹度檢核.....46
表4-1 會議討論與參與者資料表...48
表4-2 個案試行資料表...........49
表4-3 返校醫療照護模式之核心目標及措施擬定過程..57

圖目錄
圖2-1 行動研究循環螺旋圖........24
圖2-2 Lewin行動研究循環表徵.....25
圖3-1 父母決定癌症兒童返校就學的考量因素........35
圖3-2 癌症兒童返校後面臨的壓力...........36
圖3-3 學校老師希望暸解的照護資訊.........37
圖3-4 學齡期癌症兒童返校與醫療照護現況及困境綜合分析圖...40
圖3-5 學齡期癌症兒童返校醫療照護模式發展之行動循環圖.....44
圖3-6 行動過程執行時間...........45
圖4-1 返校醫療照護措施文件內容修訂時間進度......61
圖4-2 醫療單位與家庭和學校之溝通系統 ...........100
圖4-3 學齡期癌症兒童返校醫療照護模式圖..........101

附件目錄
附件一 國立成功大學醫學院附設醫院小兒科病房 家庭會議記錄..................129
附件二 國立成功大學醫學院附設醫院小兒科病房 出院準備服務會議記錄................130
附件三 國立成功大學醫學院附設醫院小兒科病房癌症兒童返校照護家屬會議記錄........131
附件四 癌症兒童返校照護家屬會議須知.........133
附件五 國立成功大學醫學院附設醫院小兒科病房 學校電話聯繫記錄..................134
附件六 癌症兒童返校醫療照護文件資料.........135
附件七 國立成功大學醫學院附設醫院 兒童返校照護與適應評估回覆單-學校版...........136
附件八 國立成功大學醫學院附設醫院 兒童返校照護與適應評估回覆單-父母版...........137
附件九 國立成功大學醫學院附設醫院小兒科病房 國中(小)癌症兒童返校醫療照護流程圖..138
附件十 人體試驗委員會同意臨床試驗證明書.....140





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