照護一位學齡期兒童頸椎牽引之護理經驗

Nursing Experience in Caring for a School-Age Child Patient Wearing a Halo-Vest

侯采緹(Tsai-Ti Hou) ； 曾紀瑩(Chi-Ying Tseng) ； 劉又瑛(Yu-Ying Liu)

《臺大護理雜誌》 17卷1期 (2021/01) Pp. 127-139

https://doi.org/10.6740/NTUHJN.202101_17(1).0012

摘要

本文探討一位學齡期女童因寰樞椎脫位，使用頸椎外固定器牽引之身體心像改變及因應之護理經驗。照護期間為2018年8月21日至9月17日，個案術前因害怕手術開始出現哭鬧及不配合行為，術後頭上八根顱釘置於頭骨內及Halo-Vest笨重外觀，開始出現低落、沮喪及不與外界接觸等行為。經由臨床直接照護、身體評估、觀察及會談照護進行生理、心理、社會三大層面的資料收集，確立個案主要護理問題有術前焦慮、身體心像改變及案母有照顧者角色緊張等。經由直接照顧建立護病信任關係，藉由圖片說明、觸摸醫療器材，減少術前焦慮；透過繪圖方式、手作活動、影片欣賞及神奇寶貝角色變換，增加個案自信心並能正向面對其身體心像的改變；術後衛教傷口及頭部清潔過程，鼓勵案母能共同參與照護，運用回覆示教方式，使其熟悉照護技巧。建議兒科護理師可運用治療性遊戲及手作活動的能力，讓學齡期兒童透過「玩中學習」方式，減少對手術之焦慮感，術後較能正向面對改變。

關鍵字

學齡期兒童 ； 術前焦慮 ； 身體心像改變 ； 頸椎外固定器

並列摘要

This article reports the nursing experience in caring for a school-age girl who wore a halo-vest for atlantoaxial dislocation, with emphasis on the child's altered body image and the interventions taken to address this problem. Nursing care for the child lasted from August 21 to September 17, 2018. Before surgery, fear-induced crying, resistance, and noncompliant behavior were observed. After surgery, the eight bolts on her skull and the cumbersome halo-vest caused the child to exhibit signs of depression, distress, and self-isolation. Through direct clinical care, physical assessment, observation, and counseling, we collected physiological, psychological, and social information and determined that the child had experienced preoperational anxiety and an altered body image, and the child's mother had developed caregiver role strain. The nursing interventions were as follows: (1) establishing nurse-patient trust through direct care; (2) developing customized care procedures; (3) relieving preoperative anxiety by explaining the surgical process with illustrations and encouraging the child to touch the medical equipment to be used; (4) improving the child's self-esteem to positively confront her altered postsurgical body image by drawing pictures, making handicrafts, watching videos, and playing Pokémon role-switching games; and (5) encouraging the child's mother to participate in postsurgical wound care and head cleaning and applying the return-demonstration method to improve the mother's care skills. Given that therapeutic play and making handicrafts allow child patients to learn through playing, pediatric nurses are advised to employ such measures to alleviate these patients' preoperative anxiety and prepare them for the changes they will encounter after surgery.

並列關鍵字

school-age child ； preoperative anxiety ； altered body image ； halo-vest