運用遊戲治療照顧一位威爾姆氏腫瘤病童之護理經驗

A Nursing Experience of Using Therapeutic Play to a Toddler with Wilms' Tumor

塗尹桾(Yin-Chun Tu) ； 邵玉如(Yu-Ju Shao) ； 游雅蘭(Ya-Lan Yu)

《榮總護理》 37卷1期 (2020/03) Pp. 83-90

https://doi.org/10.6142/VGHN.202003_37(1).0009

摘要

本文係描述運用遊戲治療協助一位威爾姆氏腫瘤住院病童之照護經驗。護理期間自2018年3月14日至4月23日，筆者透過觀察、身體評估及照護過程收集資料，依生理、心理、社會及靈性等四層面進行整體性護理評估，確立有體液容積過量、焦慮、疼痛、照顧者角色緊張等4項健康問題。照護期間以維持病童體液容積之平衡為首要，協助渡過急性期；病童因住院產生分離焦慮，因疾病導致傷口疼痛而哭鬧不安，藉由轉介藝術治療師，透過角色扮演及建構式遊戲，提供合適的情緒轉移及照護；建立良好的護病關係，主動關懷病童母親，引導其說出面對病童在治療過程中的感受，提供疾病照護資訊及治療計畫，讓其接受病童生病的事實，並發展出適應的行為，學習照護技巧，使家庭能因應病童因疾病所帶來的身心靈上的衝擊。筆者建議在兒童照護中，可善用遊戲治療的療癒力，降低病童就醫過程中的不適、焦慮及恐懼，並增加其抗壓性以調適住院期間的壓力，使其能放鬆緊繃的心，帶著愉悅的心情面對接下來的挑戰，進而達到雙贏的局面，願將此照護經驗與大家分享。

關鍵字

威爾姆氏腫瘤 ； 遊戲治療 ； 疼痛 ； 焦慮 ； 照顧者角色緊張

並列摘要

This paper describes a care experience of a toddler with Wilms' tumor. The nursing period was from March 14 to April 23, 2018. Data were collected through observation, physical assessments, medical records, and direct patient care. A holistic approach comprising physical, psychological, social, and spiritual assessments was used to evaluate the patient. The results revealed that he had body fluid overload, anxiety, acute pain, and anxiety from caregiver. We provided individualized nursing interventions to prevent fluid volume overload in the body and assist the patient cope with the critical stage. This patient developed separation anxiety, frequent crying, and wound pain during hospitalization. Thus, we engaged this child in art therapy and provided emotional distraction activities through role play and constructive games to develop a strong relationship with the medical staff. We also established a close nurse-parent connection by proactively providing medical information to the mother and sharing the treatment plan with her to ease her frustration regarding the denial of hemodialysis and chemotherapy for her child. We also assisted the mother to adapt to the disruption in daily life caused by the disease and in developing nursing skills. Therapeutic play heals an individual through relaxation, concentration, and pleasure. The approach can help a sick child adapt to the sudden changes caused by the disease during the acute critical stage. We present this case report to assist people experiencing similar ailments.

並列關鍵字

Wilms' tumor ； therapeutic play ； pain ； anxiety ； caregiver role strain

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