照顧一位開心手術後幼兒期兒童之護理經驗

本文主要描述照顧一位兩歲六個月幼兒，因肺動脈狹窄開刀住院之護理經驗。筆者於2019年4月18日至4月24日照護期間，經由觀察、身體評估、陪伴傾聽、直接照護等方式收集資料，運用系統性評估歸納出病童有急性疼痛、恐懼、潛在危險性感染及案母有照顧者角色緊張之健康問題。照護期間每日的治療及換藥造成病童的疼痛及恐懼，案母對於返家後手術傷口照護引發焦慮情緒，不斷反覆詢問關於疾病的治療及照護，引發筆者書寫照護過程之動機。筆者依據各項健康問題提供合宜之護理措施，給予持續性的照護，在治療期間使用立體、可愛的貼紙與病童拉近距離、鼓勵病童，並藉由治療性遊戲讓病童熟悉換藥步驟，降低恐懼，傾聽案母的想法，使用衛教單張提供術後返家相關指導，並於出院前評估學習成效，鼓勵照顧者參與照護並給予正向支持。建議往後照護此類病童時，除提供個別性措施以處理幼兒的生理、心理問題外，亦須評估照顧者的角色及能力，以使照顧者可參與住院及回家後的居家照護，提升病童照護品質。

關鍵字

幼兒期；開心手術；疼痛；恐懼；照顧者角色緊張

並列摘要

This article describes the nursing experience of caring for a two-year and six-month-old child who was hospitalized for pulmonary artery stenosis. Nursing care was provided between April 18 to 24, 2019. Data were collected through observation, physical assessment, companion listening, Nursing care activity. The systematic assessment was used as assessment guidelines. Four nursing problems were identified as acute pain, fear, potentially dangerous infections and the mother presented caregiver role strain. The author gave continuous care, applied stickers and therapeutic game to familiarize the case with the dressing steps and reduce fear. Listened to the main caregiver's thoughts, used the health education leaflet to provide guidance on going back home after the hospitalization, and gave positive support. When caring similar children in the future, we recommended not only solve children's physical and psychological problems but also evaluate parents caring ability to improve their skill to care their children after hospitalization.

並列關鍵字

toddler ； open heart surgery ； pain ； fear ； caregiver role strain

參考文獻

吳麗敏、陳宜坊、陳妤謙、陳寶如(2017)．治療性遊戲之臨床運用．馬偕護理雜誌，11(1)，7-17。[Wu, L. M., Chen, Y. F., Chen, Y. C. & Chen, B. R. (2017). Clinical practice of the therapeutic play, Journal of MacKay Nursing, 11(1), 7-17.] https://doi.org/10.29415/JMKN.201701_11(1).0001

林情微(2017)．運用Watson關懷理論照顧一位學齡前期兒童經歷開心手術之護理經驗．彰化護理，24(4)，91-104。[Lin, c. w. (2017). Utilizing watson's caring theory when caring a preschool child following open heart surgery, Changhua Nursing, 24(4), 91-94.] https://doi.org/10.6647/CN.201712_24(4).0009

凃辜馨儀、蔡榮美、吳妙(2017)．運用紐曼模式於幼兒期癌症復發病童之護理經驗．馬偕護理雜誌，11 (1)，92-102。[Ku, H. Y. T., Tsai, J. M., & Wu, M. (2017). case study: nursing experience of a toddler with cancer recurrence using Neuman's System Model, Journal of MacKay Nursing, 11(1), 92-102.] https://doi.org/10.29415/JMKN.201701_11(1).0008

張綺紋、姜月桃、余幸宜(2017)．兒童治療性遊戲臨床運用之探討．源遠護理，11(1)，44-51。[Chang, C. W., Chiang, Y. T., & Yu, H. Y. (2017). Clinical application of therapeutic play in children, Yuan-Yuan Nursing, 11(1), 44-51.] https://doi.org/10.6530/YYN/2017.5.4

莊孟昀、陳麗月(2017)．提昇外傷科病人出院前傷口自我照護正確率．長庚護理，28 (2)，229-241。[Chuang, M. Y., & Chen, L. Y. (2017). Promoting accuracy on self-care for wound of trauma patients before discharge, Chang Gung Nursing, 28(2), 229-241.] https://doi.org/10.3966/102673012017062802004

國際替代計量

照顧一位開心手術後幼兒期兒童之護理經驗

全文下載

主題瀏覽