醫院兒童心理工作者運用遊戲之臨床經驗探析

本研究主要以醫院兒童心理工作者視框，探究從事住院兒童心理實務工作中醫院遊戲的執行經驗。以質性研究中的半結構訪談法蒐集8位研究參與者經驗，以探究國內醫院兒童心理工作者運用醫院遊戲的現況，了解醫院遊戲的內涵，以及醫院遊戲的介入對病童帶來的影響，並從中探究提升醫院兒童心理工作者運用遊戲作為介入的可行方式。主要研究結果如下：一、醫院兒童心理工作的介入情境：1.時間人力有限，仰賴一線工作者準確的評估和篩選；2.介入情境需考量病童疾病階段、醫療處置、心理治療的評估和目標設定；3.與家庭工作，將照顧者視為工作夥伴；4.不同心理訓練背景的臨床工作者擅長運用的技術和著重介入焦點不盡相同二、醫院遊戲的運用經驗：1.因應醫院場域衍生出的床邊遊戲；2.個別心理治療取向及介入目標，影響醫院遊戲的介入形式；3.針對病童的心理需求進行評估，並選用合適的醫院遊戲作為介入；4.搭配心理治療技巧發揮醫院遊戲的療效；5.熟知媒材的特性和運用方法，促進病童心理歷程的推移三、醫院遊戲介入的影響：1.幫助病童調節醫院中的情緒經驗；2.協助病童在醫院中發展出控制感；3.臨床工作者能在過程中與住院兒童建立治療性的關係；4.協助病童面對醫療處置，發展個別化的因應策略；5.幫助住院兒童整合住院過程中正向和負向的經驗；6.持續住院兒童正常的心理發展和人際互動；7.減少因治療可能產生的創傷經驗及降低醫院的成本和人力四、臨床工作者的觀察和省思：1.調整工作策略以因應快速變動的醫院場域；2. 臨床工作者須具備多樣化的角色功能；3.對自身專業的認同及專業處境的理解；4.持續裝備自己的能力以勝任工作角色五、醫院兒童心理工作模式的初步建議：1.以生態合作系統來理解和運用住院兒童的心理資源；2.在醫院系統內進行住院兒童心理工作的分工與分級合作研究者依據研究結果，進行綜合討論提升國內使用醫院遊戲從事病童心理工作的可行方式，並據此對臨床工作者、醫院及相關系統、病童家長、醫院兒童心理工作者訓練及督導課程，以及後續相關研究提出建議。

關鍵字

醫院兒童心理工作者；住院兒童；醫院遊戲

並列摘要

The purpose of the study was to examine the implementation of hospital play activities through a hospital children psychotherapist’s frame. Semi-structured interviews were conducted with 8 participants. With the interview, the study looked into (A) the circumstances of the implementation of hospital play in Taiwan, (B) the core of hospital play activities, and (C) the effect of the play intervention. The main findings include: 1、 The intervention context of hospital children psychological treatment. a) With limited time and short of human resource, accurate assessment and filtering at the forefront are needed. b) The intervention of the treatment should consider the diagnosis stage, the medical procedure, the assessment of psychotherapy, and the set goal of the children. c) To partner with the family, to see caregivers as fellow workers. d) The applied techniques and the intervention focus varies from the training background of the psychotherapist. 2、 The practice experience of play intervention. a) Bedside play activities are derived from hospital context. b) The psychotherapy orientation and the interventional goal influences the type of play intervention. c) To assess child’s psychological need first, then choose appropriate play activities as an intervention. d) To combine psychotherapy techniques to enhance the therapeutic effect of play activities. e) To be familiar with different material and its application would help children to aware the meaning of their psychological process. 3、 The effect of the intervention of hospital play. a) To help to regulate hospitalized children’s emotions experience. b) To help hospitalized children develop a sense of control in the hospital. c) Healthcare providers can build up a therapeutic relationship with hospitalized children through the treatment. d) Assisting hospitalized children to preparing and rehearsal of their treatment, developing the coping strategies of individual client. e) To help hospitalized children integrate their positive and negative experiences. f) To maintain hospitalized children’s psychological development and interpersonal interaction. g) To decrease traumatic experiences from the treatment, reduce the financial and human resources costs of the hospital. 4、 The observation and reflection of the psychotherapist: a) Adjusting coping strategies to react to the fast pace of the hospital. b) Be able to play as variety roles. c) To identify their own profession and comprehend their own position. d) Keep improving skills to competent their job. 5、 Preliminary suggestions for hospital children psychotherapeutic workers. a) To comprehend and utilize hospitalized children’s psychological resources through ecological systems theory. b) To build a well-organized and more cooperative hospitalized children psychotherapeutic treatment system. According to the result, practical methods for child psychotherapists to enhance the implementation of play activities in the hospital are discussed. Suggestions are offered for hospital and relative medical systems, parents, and the training and supervisory courses planning of hospital children psychotherapist. Suggestions for future research are also advised.