運用治療性遊戲協助一位學齡前期支氣管肺炎病童接受胸腔物理治療之成效

The Effectiveness of Applying Therapeutic Play to Help a Preschooler with Bronchopneumonia to Accept Chest Physiotherapy

本個案報告主要在探討應用治療性遊戲對一位罹患支氣管肺炎之學齡前期兒童接受胸腔物理治療之護理成效。由於個案出現退縮、抗拒服藥及蒸氣吸入、不願接受胸部叩擊及攝取水份、無法執行深呼吸動作，而導致無法有效排除痰液及肺部擴張，因此結合情緒宣洩性、指導性與生理健康促進性遊戲種類之治療性遊戲，利用布偶角色扮演及迷宮尋寶闖關遊戲及正增強策略來鼓勵個案表達其情緒感受。個案在治療性遊戲後由抗拒轉變為願意接受蒸氣吸入、服藥、胸部叩擊、深呼吸練習及增加水份攝取，並順利達成胸腔物理治療措施的護理目標。兒科護理人員若能持有「無創傷性照護」的理念，適當運用治療性遊戲來協助病童接受胸腔物理治療，將可使心理創傷減至最低，並促進病童的最佳適應。

This case report described nursing care of applying therapeutic play to help a preschooler with bronchopneumonia to accept chest physiotherapy (CPT). Due to her withdrawal and resistance to accept medications and steam inhalation, the patient was unwilling to accept chest percussion and intake water, and unable to perform deep breathing, leading to ineffective sputum expelling and lung expansion. We combined emotional outlet play, instructional play, and physiological enhancing play with role play of puppets, a maze of treasure finding games, and positive reinforcement strategies to encourage emotional expression. After completing therapeutic play, the patient were willing to accept steam inhalation, take drugs, receive chest percussion, perform deep breathing exercise, and increase the amount of fluid intake. Nursing goal of CPT was successfully achieved. Pediatric nurses are advised to utilize the concept of “atraumatic care” and properly apply therapeutic play to help children to accept CPT. Such practice would largely decrease psychological distress and promote adaptation process.