運用治療性遊戲於一位急性白血病學齡前期兒童之護理經驗

Nursing Care Experience: Therapeutic Play for an Acute Leukemia Preschooler Patient

吳喬巧(Chiao-Chiao Wu) ； 陳永薇(Yung-Wei Chen) ； 洪嘉玟(Chia-Wen Hung)

《腫瘤護理雜誌》 17卷2期 (2017/12) Pp. 121-133

https://doi.org/10.3966/168395442017121702010

摘要

本文運用治療性遊戲於一位罹患急性淋巴性白血病學齡前期兒童的護理經驗，筆者於2014年1月21日至2月5日護理期間運用Gordon十一項健康功能型態評估，經由觀察、會談、身體評估及實際照護等方式，確立個案有血小板低下的現存性損傷，對於住院期間接受侵入性治療的恐懼及對陌生人及環境所引發的分離焦慮等護理問題。照護過程中筆者針對個案的發展特色，評估個案的需求，設計適合的治療性遊戲方式於照護過程中，先以親切、友善的態度與個案及家屬建立良好的治療性關係，運用專業知識，提供個案及家屬在生理及心理方面的照護指導，運用行動遊戲車、繪畫、繪本故事及角色扮演等遊戲，予以支持及鼓勵，協助個案接受化學治療所面臨的症狀及治療，讓個案及家屬增進照護知識，降低因侵入性治療引發之恐懼及緩解對陌生人、住院環境的不安全感所致之分離焦慮，改善住院壓力。惟在圖畫分析上仍需專業技巧，建議增進兒科護理人員的治療性遊戲專業能力或藉由跨領域團隊，安排遊戲治療師、心理諮詢師等領域專業人員介入，以提升兒科護理人員專業知識，促進護理品質。期望此護理經驗能提供兒科護理人員在照護類似個案有更多元化的參考。

關鍵字

白血病 ； 學齡前期兒童 ； 治療性遊戲

並列摘要

This article describes the nursing care experience of therapeutic play for an acute lymphoblastic leukemia preschooler patient from 2014/1/21 to 2014/2/5. The nursing staff used observations, conversations, physical assessments and actual care for data collection by applying Gordon’s Eleven Functional Health Patterns. We found that the nursing assessment clarified a certain nursing issues including: the presence of injury related to thrombocytopenia, the fear during hospitalized of invasive treatment and strangers, such as doctors and nursing staff, and of the environment caused by separation anxiety. During the care process, I aimed to identify the characters of patients to assess the patient needs in order to design the unique game play for the treatment. First, with a warm and friendly attitude, we established a good therapeutic relationship with patients and their families. Then, coupled with our professional knowledge, we provided care guidance of physiology and psychological aspects to patients and their families, then, we utilized action games cars, painting, picture story books and role-play games to support and encourage patients and their families to assist the patients to face the symptoms and treatment. With those measures, we enriched knowledge of care for patients and their families; it could help reduce patients fear of invasive treatment, strangers, hospital environment and handle separation anxiety better to ease the hospitalization pressure. Even after we had done so much effort, more professional skills are still needed in picture interpretation. Therefore, we recommend training of professional competence in therapeutic games for pediatric nursing staff or the cross-training among teams, including play therapists, psychological counselors and other professionals to facilitate the growth development of pediatric nurses and promote quality of care. We expect this nursing experience could provide pediatric nursing staff more diversified reference in caring for similar patients.

並列關鍵字

Leukemia ； preschooler ； therapeutic play

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