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研究生:羅燕惠
研究生(外文):Yen-Hui Lo
論文名稱:母親面對惡性骨肉瘤青少年經歷截肢術後的照顧經驗
論文名稱(外文):Mothers’ Care Experience for Adolescence with Malignant Osteosarcoma after Amputation
指導教授:陳淑齡陳淑齡引用關係
指導教授(外文):Shu-Ling Chen
口試委員:巫康熙楊惠娟
口試委員(外文):Kang-Hsi WuHui-Chuan Yang
口試日期:2020-07-31
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:151
中文關鍵詞:惡性骨肉瘤青少年截肢母親經驗
外文關鍵詞:Malignant osteosarcomaadolescenceamputationmotherexperience
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惡性骨肉瘤約佔兒童骨癌的一半,是最常見的兒童骨癌,發生率在兒童癌症中約佔4.9﹪,好發年齡為的是13至16歲,且在青春期的腫瘤中排行第三位,骨肉瘤青少年接受外科手術切除,若腫瘤已侵犯到主要的神經血管,須採截肢手術,顯示接受癌症治療可能會經歷一個身體的改變,且社會心理和情感顯著影響,除了對青少年帶來極大的壓力外,對家庭成員承受生理、心理、情緒及生活上衝擊。然而目前鮮少探討青少年罹患惡性骨肉瘤接受截肢後母親照顧經驗,因此本研究旨在探討母親照顧骨肉瘤青少年截肢後的照護經驗,採質性研究,以立意取樣,半結構式深入訪談方式,在中部某醫學大學附設兒童醫院病房收集資料,共訪談三位母親,每位訪談60-90分鐘,共訪3次,並將語音檔轉成逐字稿,以內容分析法進行資料分析,研究結果歸納出四個主題:壹、回首孩子截肢的宿命;貳、截肢後適應階段;參、預期失去孩子;肆、心相繫逝去孩子。本研究呈現出母親照顧惡性骨肉瘤青少年經歷截肢術後的真實經驗及其內心感受,可協助護理人員提供個別性的護理照顧,促進臨床的護理實務,也做為未來發展惡性骨肉瘤整體性健康照護之依據。

關鍵詞:惡性骨肉瘤、青少年、截肢、母親、經驗


Malignant osteosarcoma accounts for about half of bone cancers in children, making it the most common one. Its incidence is about 4.9% of childhood cancers. The prevalence age is 13 to 16, and it ranks third among adolescent tumors. Adolescents with osteosarcoma undergo surgical resection. If the tumor has invaded the main nerves and blood vessels, amputation must be performed. This outcome may cause physical changes and have significant social, psychological and emotional impacts. In addition to causing great stress to the adolescents themselves, family members also bear physical, psychological, emotional and life impacts. However, few researchers have explored mothers’ experiences of caring for adolescents with malignant osteosarcoma after amputation. Therefore, the purpose of this study was to explore these mothers’ experiences of caring for adolescents with malignant osteosarcoma after amputation. This research employed a qualitative approach, using purposive sampling and semi-structured in-depth interviews to collect data. Data were collected at the children’s hospital attached to China Medical University Hospital. Three mothers were interviewed and each interview was about 60–90 minutes total 3 times. The recordings obtained from the interviews were transcribed into verbatim manuscripts and analyzed by content analysis.
The results of the study indicated four themes: 1. Looking back on the inevitability of the child's amputation; 2. Adapting during the post-amputation stage; 3. Anticipating the child’s death; 4. Missing the dead child. This study presents the mother’s experience of and inner feelings about caring for children with malignant osteosarcoma after amputation. The findings should allow nursing staff to provide individualized nursing care, promote clinical nursing practice, and form a basis for the development of holistic health care for patients with malignant osteosarcoma in the future.

Keywords: Malignant osteosarcoma, adolescence, amputation, mother, experience

目 錄

致謝…………………………………………………………………………………………………………………………………………………………………………………………………Ⅰ
中文摘要………………………………………………………………………………………………………………………………………………………………………………………Ⅱ
Abstract……………………………………………………………………………………………………………………………………………………………………………………Ⅲ
目錄………………………………………………………………………………………………………………………………………………………………………………………………Ⅳ
表目錄…………………………………………………………………………………………………………………………………………………………………………………………Ⅵ
圖目錄…………………………………………………………………………………………………………………………………………………………………………………………Ⅵ
附錄………………………………………………………………………………………………………………………………………………………………………………………………Ⅵ
第壹章緒論 ………………………………………………………………………………………………………………………………………………………………………………1
第一節 研究背景及重要性與目的 …………………………………………………………………………………………………………………………………1
第二節 研究問題 ……………………………………………………………………………………………………………………………………………………………………8
第三節 名詞解釋 ……………………………………………………………………………………………………………………………………………………………………9
第貳章文獻查證 ……………………………………………………………………………………………………………………………………………………………………11
第一節 惡性骨肉瘤簡介與治療 …………………………………………………………………………………………………………………………………11
第二節 母親於癌症青少年照護議題 …………………………………………………………………………………………………………………………17
第三節 母親及青少年截肢所面臨的問 ……………………………………………………………………………………………………………………29
第四節 國內外骨肉瘤截肢照護之相關研究……………………………………………………………………………………………………………36
第參章研究設計 …………………………………………………………………………………………………………………………………………………………………46
第一節 資料之收集………………………………………………………………………………………………………………………………………………………………47
第二節 研究情境及對象……………………………………………………………………………………………………………………………………………………48
第三節 研究工具……………………………………………………………………………………………………………………………………………………………………49
第四節 研究步驟 …………………………………………………………………………………………………………………………………………………………………50
第五節 研究資料的處理與分析 ……………………………………………………………………………………………………………………………………52
第六節 研究嚴謹度 ……………………………………………………………………………………………………………………………………………………………53
第七節 研究倫理考量…………………………………………………………………………………………………………………………………………………………56
第肆章結果………………………………………………………………………………………………………………………………………………………………………………57
壹 回首孩子截肢的宿命 …………………………………………………………………………………………………………………………………………………60
貳 截肢後適應階段 ……………………………………………………………………………………………………………………………………………………………66
參 預期失去孩子 ………………………………………………………………………………………………………………………………………………………………85
肆 心相繫逝去孩子 ……………………………………………………………………………………………………………………………………………………………94
第伍章討論………………………………………………………………………………………………………………………………………………………………………………98
第一節 研究結果與其他文獻相比較……………………………………………………………………………………………………………………………98
第二節 研究概念架構之形成與分析 ………………………………………………………………………………………………………………………112
第陸章結論與建議………………………………………………………………………………………………………………………………………………………………114
參考文獻…………………………………………………………………………………………………………………………………………………………………………………119
中文部分…………………………………………………………………………………………………………………………………………………………………………………119
英文部分…………………………………………………………………………………………………………………………………………………………………………………123

表目錄

表一 罹患惡性骨肉瘤其家庭經歷的相關性質性研究彙整一覽表……………………………………………………………38
表二 近十年國內、外母親照顧癌症病童相關性質性研究彙整一覽表…………………………………………………40
表三 研究對象基本資料表……………………………………………………………………………………………………………………………………………57
表四 母親面對惡性骨肉瘤青少年經歷截肢術後的照顧經驗主題及次主題 ………………………………………59


圖目錄
圖一 國內針對探討截肢的質性研究(研究者自繪)…………………………………………………………………………………………7
圖二 母親面對惡性骨肉瘤青少年經歷截肢術後的照顧經驗概念架構圖……………………………………………112


附錄
附錄一 臨床實驗/人體驗就通過證明……………………………………………………………………………………………………………………133
附錄二 問卷研究首訪者說明及同意書…………………………………………………………………………………………………………………134
附錄三 訪談資料分析稿………………………………………………………………………………………………………………………………………………139

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