近年來兒童癌症治療已有明顯進步，照護目標已延伸至使兒童及家人共同面對癌症。當父母專注於癌症病童照顧時，家中其他孩子易被忽略。過去20年間國內缺乏癌症病童手足之相關研究文獻。當癌症病童與家庭成員面臨住院期間一連串之複雜治療過程與壓力時，護理人員需要具備更多的資訊以協助癌症病童手足生活上之適應。本研究目的為探索癌症病童自診斷六個月後，家中六至十二歲學齡期之健康手足所真實經驗到的生活情形。採現象學研究法，研究者深入貼近七位健康手足，以繪圖方式引發健康手足討論及收集資料，並建立低結構性訪談指引，訪談病童手足其日常生活上之重要他人共17位。所有手足繪圖過程及訪談內容藉由錄音撰寫為逐字稿以進行評估。資料分析之過程採用編輯式分析法及Colaizzi (1978)所建議之現象學研究步驟進行，並以ATLAS-ti 5.0質性分析軟體協助整理圖、音及文本。研究結果呈現出癌症病童手足之生活經驗涵蓋了五個主要範疇：初獲癌症診斷之衝擊、矛盾的情感與行為、對癌症的認知與擔憂、獨立之展現為家庭灌注力量、震盪後情感的重新安置。本研究結果除了增加臨床護理人員了解癌症病童學齡期手足生活處境之真實經驗，進而解析手足面臨病童罹病過程之相關衝擊與需求，提供癌症病童家庭成員適切的幫助，促進未來家庭護理模式之建立。

Caregiver who’s hospitalized child with cancer might neglect the other child at home. Nursing providers need more information related to siblings for their lived experience if one of the family members were diagnosed as cancer and receiving a variety of treatment protocols. A phenomenological research was conducted at southern Taiwan. Seven children aged 6~12 years old were approached who had a sibling with cancer. Data was collected from the subject’s drawing and story telling. The significant relatives and teachers of each subject were also interviewed. Qualitative data analysis method proposed by the ATLAS-ti 5.0 qualitative analysis software and Colaizzi (1978) method were used. The findings indicated that there were five categories of lived experiences: The impact of sibling diagnosed as cancer, confused emotion and behavior, cognition and worrying about the disease, independence and capable changed for the family, returning to new spirituality after the shock. Siblings do experience lived changes and have potential mal-adaptation. Nursing providers need to be awared of these changes and identify their health needs among caregivers and siblings of children with cancer. The findings of this study may provide further information for clinical nursing to understand the needs of siblings of children with cancer.

參考文獻
中文部分
中華民國兒童癌症基金會（2005年6月5日）．認識兒童癌症．取自
http://ccf.wingnet.com.tw
王如華（1982）．中國家庭內癌症患孩對其手足影響之研究．護理雜誌，29（4），81-91。
江文瑜（1996）．口述史法．於胡幼慧主編，質性研究理論、方法及本土女性研究實例(pp. 249-266) ‧台北：巨流。
江季蓁、駱麗華（2002）．新診斷白血病兒童住院期間主要照顧者之生活品質．護理雜誌，49（2），42-50。
呂素貞（2005）．超越語言的力量－藝術治療在安寧病房之故事．台北：張老師文化事業。
余玉眉（1999）．方法論．於余玉眉、田聖芳、蔣欣欣編，質性研究－田野研究法於護理學之應用(pp. 17-147 )．台北：巨流。
余玉眉（2002）．家庭護理師：架構與實務．台北：惠文。
泛瓊方（1996）．藝術治療－家庭動力繪畫概論．台北：五南。
林本炫（2004）．質性研究資料分析電腦軟體在質性研究中之應用．於林本炫、何明修編，質性研究方法及其超越(pp. 1-22)．嘉義：南華大學社教所。
林安麗（2000）．白血病兒童手足的壓力源及因應行為．未發表碩士論文，台灣大學護理學系研究所。
徐宗國（1996）‧紮根理論研究法‧於胡幼慧主編，質性研究理論、方法及本土女性研究實例(pp. 47-73)‧台北：巨流。
陳月枝（1996）．與癌症兒童溝通的一種方法：畫圖．護理新象，6（1），250-258。
陳月枝（2000）．緒論．於陳月枝總校閱，質性護理研究方法(pp. 1-20)．台北：護望。
陳月枝（2004）．台灣癌症兒童及其家庭之護理研究．金繼春 (主持人)，兒童與其家庭之實證性健康照護研討會，高雄醫學大學。
陳昌蘭（2002）．兒童手足關係之探討．國教之聲，34（2），49-55。
陳淑音、駱麗華（2000）．一位學齡前期白血病兒童家庭面對癌症與治療之心路歷程．護理雜誌，47（1），86-92。
陳勤惠（2000）．繪畫運用在遊戲治療中．國教天地，140，18-24。
崔琦、駱麗華（2005）．癌症病童手足生活經驗改變的初探．護理雜誌，55（5），24-32。
畢恆達（1995）‧生活經驗研究之反省：詮釋學的觀點．本土心理學研究，4，224-259。
畢恆達（1996）‧詮釋學與質性研究‧於胡幼慧主編，質性研究理論、方法及本土女性研究實例(pp. 27-45)‧台北：巨流。
梁妃儀，洪德仁，蔡篤堅（2003）．協助社群認同發展的口述歷史實踐－結合理論與實務的操作手冊．台北：唐山
曾紀瑩（1996）．兒童罹患癌症對父母之衝擊與需求．護理新象，47（4），11-16。
張梅菊（1997）．國小兒童之家庭動力畫與家庭關係之相關研究．未發表之碩士論文，高雄師範大學。
趙可式（2000）．詮釋學．於陳月枝總校閱，質性護理研究方法(pp. 87-130)．台北：護望。
雷若莉（2002）．質性研究設計．於李選總校閱，護理研究與應用(pp. 197-243)．台北：華杏。
蔣欣欣、張碧芬、余玉眉（2001）．從護理人員角色的創造探討護理倫理的實踐．哲學雜誌，33，88-106。
劉仲冬（1996）．民族誌研究方法與實例．於胡幼慧主編，質性研究理論、方法及本土女性研究實例(pp. 173-193) ‧台北：巨流。
劉淑娟（2000）．嚴謹度．於陳月枝總校閱，質性護理研究方法．台北：護望。
劉碧玉（1980）．以圖畫投設法探討住院兒童對手術過程中之反應．護理雜誌，27（4），29-37。
穆佩芬（1996）．現象學研究法．護理研究，4（2），195-202。
穆佩芬（2000）．現象學研究法．於陳月枝總校閱．質性護理研究方法．台北：護望。
穆佩芬、馬鳳岐、顧小明、許洪坤、黃碧桃（2000）有罹患癌症兒童之家庭的壓力--對母親的衝擊．護理研究，8（5），568-577。
謝淑娟、陳季員（2000）．應用繪畫來探討一位學齡期兒童住院經驗的知覺．護
理雜誌，47（3），41-50。
戴臆珊、駱麗華、陳月枝（2003）．回顧1981～2000二十年期間台灣兒童癌症護理之相關文獻．腫瘤護理雜誌， 3（1），17-30。

英文部分
Bailey, P. H. (1997). Finding your way around qualitative methods in nursing research. Journal of Advanced Nursing, 25(1), 18-22.
Barrera, M., Fleming, C. F., & Khan, F. S. (2004). The role of emotional social support in the psychological adjustment of siblings of children with cancer. Child: Care, Health & Development, 30(2), 103-111.
Beck, C. T. (1994). Reliability and validity issues in phenomenological research. Western Journal of Nursing Research, 16(3), 254-262.
Beilin, H., & Fireman, G. (1999). The foundation of Piaget's theories: Mental and physical action. Advances in Child Development & Behavior, 27, 221-246.
Bendor, S. J. (1990). Anxiety and isolation in siblings of pediatric cancer patients: The need for prevention. Social Work in Health Care, 14(3), 17-35.
Bibace, R., & Walsh M. (1980). Development of children's concept of illness. Pediatric, 66(6), 912-917.
Burawoy, M. (1999). Critical sociology: A dialogue two science. Contemporary Sociology, 27(1), 11-20.
Burns, N., & Grove, S. K. (2001). The practice of nursing research: Conduct, critique, & utilization (4th ed., pp. 191-222). Philadelphia: Saunders.
Carbtree, B. F., & Miller, W. L. (1999). 於黃惠雯、董琬芬、梁文蓁、林兆衛譯(2003)，最新質性方法與研究Doing Qualitative Research．台北：韋伯。
Chiou, C. P. (2000). A meta-analysis of the interrelationships between the modes in Roy's adaptation model. Nursing Science Quarterly, 13(3), 252-258.
Clatworthy, S., Simon, K., & Tiedeman, M. E. (1999). Child drawing: Hospital-An instrument designed to measure the emotional status of hospitalized
school-aged children. Journal of Pediatric Nursing, 14(1), 2-9.
Cobb, B. (1956). Psychological impact of long illness and death of child on the family circle. Journal of Pediatrics, 49, 746-751.
Copp, L. A. (1989). A nurse as the patient's significant other. Journal of Professional Nursing, 5(2), 57-58.
DeChristopher, J. (1981). Children with cancer: Their perception of the health care experience. Top Clinical Nursing, 2(4), 9-19.
Dunn, J. (1983). Sibling relationships in early childhood. Child Development, 54, 787-811.
Elkayam, J., & English, K. (2003). Counseling adolescents with hearing loss with the use of self-assessment/significant other questionnaires. Journal of the American Academy of Audiology, 14(9), 485-499.
Evans, A. (2001). The influence of significant others on Australian teenagers' decisions about pregnancy resolution. Family Planning Perspectives, 33(5), 224-230.
Evans, A., Stevens, M., Cushway, D., & Houghton, J. (1992). Sibling response to childhood cancer: A new approach. Child: Care, Health & Development, 18(4), 229-244.
Furman, W., & Buhrmester, D. (1985). Children's perceptions of the qualities of sibling relationship. Child Development, 56, 448-461.
Goetting, A. (1986). The development tasks of sibling over the life cycle. Journal of Marriage and the Family, 48, 703-714.
Hamama, R., Ronen, T., & Feigin, R. (2000). Self-control, anxiety, and loneliness in siblings of children with cancer. Social Work in Health Care, 31(1), 63-83.
Havermans, T., & Eiser, C. (1994). Siblings of a child with cancer. Child: Care, Health & Development, 20(5), 309-322.
Houtzager, B. A., Grootenhuis, M. A., Caron, H. N., & Last, B. F. (2004). Quality of life and psychological adaptation in siblings of paediatric cancer patients, 2 years after diagnosis. Psycho-Oncology, 13(8), 499-511.
Houtzager, B. A., Grootenhuis, M. A., Hoekstra-Weebers, J. E., Caron, H. N., & Last, B. F. (2003). Psychosocial functioning in siblings of paediatric cancer patients one to six months after diagnosis. European Journal of Cancer, 39(10), 1423-1432.
Houtzager, B. A., Grootenhuis, M. A., & Last, B. F. (1999). Adjustment of siblings to childhood cancer: A literature review. Support Care Cancer, 7, 302-320.
Houtzager, B. A., Oort, F. J., Hoekstra-Weebers, J. E., Caron, H. N., Grootenhuis, M. A., & Last, B. F. (2004). Coping and family functioning predict longitudinal psychological adaptation of siblings of childhood cancer patients. Journal of Pediatric Psychology, 29(8), 591-605.
Huizinga, G. A., Graaf, W. T., Visser, A., Dijkstra, J. S., & Hoekstra-Weebers, J. E. (2003). Psychosocial consequences for children of a parent with cancer: A pilot study. Cancer Nursing, 26(3), 195-202.
Jenkinson, T. P. (1996). The nurse as significant other for surgical patients. Professional Nurse, 11(10), 651-652.
Kaminsky, L. D. (2002). Psychosocial adjustment in siblings of children with autism. Journal of Child Psychology & Psychiatry & Allied Disciplines, 43(2), 225-232.
Kenen, R., Arden, J. A., & Eeles, R. (2004). Healthy women from suspected hereditary breast and ovarian cancer families: The significant others in their lives. European Journal of Cancer Care, 13(2), 169-179.
Knaack, P. (1984). Phenomenological research. Western Journal of Nursing Research, 6(1), 107-114.
Labay, L. E., & Walco, G. A. (2004). Brief report: Empathy and psychological adjustment in siblings of children with cancer. Journal of Pediatric Psychology, 29(4), 309-314.
Lavigne, J. V., & Ryan, M. (1979). Psychologic adjustment of sibling of children with chronic illness. Pediatric, 63(4), 616-626.
Leavitt, M., Martinson, I. M., Liu, C., Armstrong, V., Hornberger, L., Zhang, J., et al. (1999). Common themes and ethnic difference in family care giving the first year after diagnosis of childhood cancer: Part 2. Journal of Pediatric Nursing, 14(2), 110-122.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. (pp. 281-331). Newbury Park, CA: Sage.
Lindholm, L., Rehnsfeldt, A., Arman, M., & Hamrin, E. (2002). Significant others' experience of suffering when living with women with breast cancer. Scandinavian Journal of Caring Sciences, 16(3), 248-255.
Liossi, C. (2000). Understanding children’s pain through drawing. European Journal of Art Therapy, 7, 222-225.
Martinson, I. M., Gilliss, C., Colaizzo, D. C., Freeman, M., & Bossert, E. (1990). Impact of childhood cancer on healthy school-age siblings. Cancer Nursing, 13(3), 183-190.
Mchale, S. M., & Gamble, W. G. (1989). Sibling relationships of children with disabled and nondisabled brothers and sisters. Developmental Psychology, 25, 421-429.
Murray, J. S. (1998). The lived experience of childhood cancer: One sibling's perspective. Issues in Comprehensive Pediatric Nursing, 21(4), 217-227.
Murray, J. S. (1999). Siblings of children with cancer: A review of the literature. Journal of Pediatric Oncology Nursing, 16(1), 25-34.
Murray, J. S. (2000). Understanding sibling adaptation to childhood cancer. Issues in Comprehensive Pediatric Nursing, 23(1), 39-47.
Murray, J. S. (2001a). Self-concept of siblings of children with cancer. Issues in Comprehensive Pediatric Nursing, 24(2), 85-94.
Murray, J. S. (2001b). Social support for school-aged siblings of children with cancer: A comparison between parent and sibling perceptions. Journal of Pediatric Oncology Nursing, 18(3), 90-104.
Orpaz, R., & Korenblit, M. (1994) Family nursing in community-oriented primary health care. Internation Nursing Review, 41(5), 155-159.
Phuphaibul, R., & Muensa, W. (1999). Negative and positive adaptive behaviors of Thai school-aged children who have a sibling with cancer. Journal of Pediatric Nursing, 14(5), 342-348.
Piazza, D., & Foote, A. (1990). Roy's adaptation model: A guide for rehabilitation nursing practice. Rehabilitation Nursing, 15(5), 254-259.
Richter, L. (1995). The significant other. Journal of Emergency Nursing, 21(5), 372-373.
Robinson, K. M., & Steele, D. (1995). The relationship between health and social support in caregiving wives as perceived by significant others. Journal of Advanced Nursing, 21(1), 88-94.
Ross-Alaolmolki, K., Heinzer, M. M., Howard, R., & Marszal, S. (1995). Impact of childhood cancer on siblings and family: Family strategies for primary health care. Holistic Nursing Practice, 9(4), 66-75.
Roy, C., & Andrews, H. A. (1999). The Roy adaptation model, (2nd ed.) Norwalk, CT: Appleton & Lange.
Sahler, O. J., Roghmann, K. J., Mulhern, R. K., Carpenter, P. J., Sargent, J. R., Copeland, D. R., et al. (1997). Sibling adaptation to childhood cancer collaborative study: The association of sibling adaptation with maternal well-being, physical health, and resource use. Journal of Developmental & Behavioral Pediatrics, 18(4), 233-243.
Salsberry, P. J., Smith, M. C., & Boyd, C. O. (1989). Phenomenological research in nursing: Commentary and responses. Nursing Science Quarterly, 2(1), 9-19.
Sargent, J. R., Sahler, O. J., Roghmann, K. J., Mulhern, R. K., Barbarian, O. A., Carpenter, P. J., et al. (1995). Sibling adaptation to childhood cancer collaborative study: Siblings' perceptions of the cancer experience. Journal of Pediatric Psychology, 20(2), 151-164.
Sundaram, R. (1995). In focus: Art therapy with a hospitalized child. American
Journal of Art therapy, 34, 2-8.
Tataryn, D., & Chochinov, H. M. (2002). Predicting the trajectory of will to live in terminally ill patients. Psychosomatics, 43(5), 370-377.
Terzo, H. (1999). The effects of childhood cancer on siblings. Pediatric Nursing, 25(3), 309-311.
Thibodeau, S. M. (1988). Sibling response to chronic illness: The role of the clinical nurse specialist. Issues in Comprehensive Pediatric Nursing, 11(1), 17-28.
Walker, C. L. (1988). Stress and coping in siblings of childhood cancer patients. Nursing Research, 37(4), 208-212.
Walker, C. L. (1990). Siblings of children with cancer. Oncology Nursing Forum, 17(3), 355-360.
Wang, R. H., & Martinson, I. M. (1996). Behavioral responses of healthy Chinese siblings to the stress of childhood cancer in the family: A longitudinal study. Journal of Pediatric Nursing, 11(6), 383-391.
Wills, B. S. (1999). The experiences of Hong Kong Chinese parents of children with acute lymphocytic leukemia. Journal of Pediatric Nursing, 14(4), 231-238.
Yeh, C. H. (2001). Adaptation in children with cancer: Research with Roy's model. Nursing Science Quarterly, 14(2), 141-148.