運用藝術治療照護學齡期兒童罹患紅斑性狼瘡之護理經驗

本文是藉由藝術治療協助一位罹患紅斑性狼瘡住院病童，透過繪畫的創作與對話，發覺自我內在的感受，進而表達、轉移其恐懼、害怕的情緒，依其年齡行為發展，提供合適護理措施之照護經驗。護理期間為2017年9月30日至10月20日期間透過觀察、直接照護及訪談方式收集資料，以Gordon十一項健康功能型態為評估工具，確立健康問題有：氣體交換功能障礙、體液容積過量、感染危險性、照顧者角色緊張。照護過程先改善病童血氧濃度，透過血液透析及血漿置換術，將多餘的水份及免疫複合物排除，降低免疫反應，有效改善肺水腫，而順利拔除氣管內管。藉由藝術治療師，運用藝術媒材的互動，經由言語的引導抒發內在壓力與恐懼，並在創作中找尋到正向的行為與因應的措施，促使病童更有勇氣面對治療期間的生理及心理不適。建議日後對於類似兒童照護，可多提供藝術治療活動，讓兒科護理人員在照護時，能善用此資源，達到全人照護目標。

關鍵字

紅斑性狼瘡；肺水腫；藝術治療；學齡期

並列摘要

This article describes a nursing experience that applies art therapy to school-age children with Systemic Lupus Erythematosus. Through creation of drawing and communication, children will sense inner self-perception, distract their horror and fear. The author applied appropriate distinctive nursing care associates with behavior development. Nursing care was provided from Sep. 30^(th) to Oct. 20^(th) in 2017, and data was collected through direct nursing, observation, and consultation. Applying 'Gordon's Eleven Functional Health Patterns' to identify four health issues include: impaired gas exchange, fluid overload, risk for infection and caregiver's role strain. During the nursing period, the author applied individualized nursing interventions to help the client stabilize ventilation, advancing gas exchange, hemodialysis and plasma exchange which can remove excess body fluid, alloantibody and antibody-antigen complex to reduce the immune responses and resolution of pulmonary edema, and hence weaning from a ventilator. Through the help of art therapists, the interaction of art media, verbal guidance to express their inner pressure and fear, and to search positive behaviors and corresponding measures during the creation, to hence encourage the pediatric patient to face the physiological and psychological discomfort during the treatment. It is suggested that nursing experience from this case study can help pediatric nursing staff to look after similar case in the future, upgrade quality of nursing care and provide continuity of caring service and hence achieve the quality of holistic health care.

並列關鍵字

systemic lupus erythematosus ； pulmonary edema ； art therapy ； school age

參考文獻

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李冠霖、曾雯琦、蔣立琦（2016）．年輕重症病人父母親於加護病房之緊急過渡期的經驗八仙塵爆事件的故事．領導護理，17(1) ， 14-26 。 https://doi.org/10.29494/LN.201603_17(1).0002

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運用藝術治療照護學齡期兒童罹患紅斑性狼瘡之護理經驗

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