運用治療性遊戲照護一位受虐兒童在急診之護理經驗

The Utilization of Therapeutic Play to an Abused Child in the Emergency Department Nursing Care Experience

林秋瑜(Chiu-Yu Lin) ； 湯婉孏(Wan-Lan Tang) ； 練美華(Mei-Hua Lien) ； 李權芳(Chuan-Fang Li)

《長庚護理》 25卷1期 (2014/03) Pp. 89-97

https://doi.org/10.6386/CGN.201403_25(1).0009

摘要

本文運用治療性遊戲照護一位學齡期兒童遭受父親虐待於急診之護理經驗。首先利用遊戲與個案建立治療性信任關係，藉由直接觀察、身體評估、角色扮演、繪畫引導等方式，從遊戲中了解個案所遭受虐待之恐懼及內心情緒。同時在遊戲中得知個案於急診留觀期間面臨與母親分離焦慮，易對人產生不信任、不易與人親近、拒絕換藥等，故運用治療性遊戲中的布偶角色扮演、繪畫等象徵性及投射性遊戲溝通技巧，引導個案說出內心感受及情緒壓力之宣洩。個案在遊戲治療後由被動轉變為主動與主護護理師有信任互動關係，願意接受換藥治療，並順利達成個案與主護護理師的溝通橋樑及提升對治療的順從性。因此深感遭受暴力的兒童身心受創是嚴重的，是需要護理人員去支持；若護理人員能持有「無創傷性照護」理念，適當運用治療性遊戲來協助了解受虐兒童心理受創及身理傷痛，使個案創傷減至最低及得到完善的照護，早日脫離受虐的夢魘。

關鍵字

治療性遊戲 ； 學齡期 ； 受虐兒童 ； 急診護理

並列摘要

In this article, we described the experiences of utilizing a therapeutic play in the emergency nursing care experience to a school-age child who had been abused by his father. First, we use the therapeutic play to establish a trust therapeutic relationship with the abused child. By the method of direct observation, physical assessment, role-playing, and painting-guide, we can understand the fear and inner emotion of the abused child. In addition, we realized from the therapeutic play that the child suffered from separation anxiety with his mother during the emergency observation period and easily distrusted people. He was hard to be coped by others and refused to accept wound care. We utilized the puppet role-playing and painting in therapeutic play, which are symbolic and projective game communication skills, to guide the abused child to say the innermost feeling and release the emotional stress. After underwent therapeutic play treatment, the child had changed from passive to active attitude to establish a good trust relationship with the primary care nursing staff and is willing to accept wound care treatment. The article can serve as a tool for nursing staff to communicate with the abused child and enhance compliance to treatment by the method of therapeutic play. The experience emphasized the importance of nursing support on recovering the physical and mental damage created by abuse. Application of the concept of ”non-traumatic care” and utilization of therapeutic play are helpful in understanding the physical and psychological trauma of the abused child.

並列關鍵字

therapeutic play ； school-age ； abused child ； emergency nursing care