Osteosarcoma Children's Adaptive Process and Behavioral Responses in Relation to Body Image Change before and after Amputation

本研究目的是探討骨癌病童接受截肢前後，面對身體心像改變之適應過程及行為反應 。研究方法是採取田野研究法，並以觀察者及視參與者的方式收集資料，收集資料的 期間自個案截之前至截肢後三個月，包括手術前的準備階段，至手術後復原及復健階 段，並依個案需要進行家庭訪視及居家護理，將個案的資料寫成行為過程紀錄，並加 以分析及歸類。資料分析結果，將個案的適應過程分為三個階段說明及討論：一、截 肢前身體心像威脅期(罹患骨癌至截肢前)：截肢前個案會試圖維持身體心像的完整性 ，而不斷的尋求各種醫療；也會因為預期身體完整性的即將遭破壞而產生預期性的哀 傷反應。二、截肢後身體心像紊亂—重組期(截肢後0至6週)：截肢後由於身體感覺、 結構、功能的明顯改變，個案會經歷許多紊亂—重組的經驗，並經由詢問、觀察、觸 摸，及學習、嘗試而逐漸確認截肢後的身體感覺及身體結構，並重健截肢後的活動功 能。三、截肢後身體心像的整合期(截肢後6至12週)是指當個案身體狀況趨穩定，並 恢復獨立活動的能力時，個案對截肢後的身體改變，呈現一種適應及接受的現象。包 括適應幻肢感的存在、接受拐杖及義肢成為身體的一部分、熟練的控制身體活動、自 我照顧日常活動及擴展活動空間等。本研究的結果可提供臨床護理之參考，使護理人 員在骨癌病童接受截肢前後，能有計劃的向他們提供照顧及支持，使兒童能發揮最大 的潛能，度過截肢所造成的身心危機，並進而重建其身體心像。 This study was based on the information collected by the “observer as particippant” field children’s amputation, especially during the periods of pre- amputation preparation, post-amputation recovery and rehabilitation. The patients’ behavior responses were recorded and then systematically categorized and analyzed by the content analysis method. The results of this study are described and discussed in the following stages of the patient’s adaptive process:1. The threatening of body image before amputation (between diagnosis and amputation) : During this stage, the patients were worried and would try to maintain the integrity of their body image as much as possible. Their inevitable fate of amputation always resulted in anticipatory grief. 2. This disorientation and reorganization of body image after amputation (0-6 weeks after amputation ): After the loss of their limbs, the patients experienced disorientation of their image due to great changes in their body structures and functions. They would try to adapt to the new situation and reorganized their body image by way of seeking information, observation, and learning to move in balance. 3. Reintegration of body image after amputation (6-12 weeks after amputation): The patients regained their ability to live independently after accommodation their body image changes and adapting themselves to phantom sensations and the use of crutch or other prosthesis. This study could be useful in improving clinical nursing for bone cancer-stricken children, because it provides insight into their skill of systematically caring and supporting such children to help them overcome their physical and psychological crises and start a new life with their greatest potential.