利用繪畫協助一位學齡期頭部手術兒童經歷身體心像改變的適應過程

A Case Study ofUsing Drawing to Help a School-Aged Child with Head Surgery Adapt to Her Body Image Changes

住院對兒童而言是一個極大的壓力事件，住院兒童常因忍受許多治療及檢查程序而產生退化性行為，故本文藉由繪畫的投射技巧來協助一位蘭格罕氏細胞組織球增生症之學齡期住院兒童經歷身體心像改變的適應過程。筆者利用參與性觀察及個別會談收集資料，經評估後確認個案的護理問題為「身體心像改變」及夜間尿床及半夜哭泣等「退行性行為」，故先藉由繪畫與個案建立信任關係，接著利用繪畫引導與鼓勵個案表達對手術及面對身體心像改變的衝擊與感受，運用繪畫的投射技巧聚焦於身體心像改變的調適，個案在住院初期的圖畫線條色彩以紅色和黑色為主，可能是擔憂與疼痛的心理投射，然而其後的整體構圖便顯得生動活潑且色彩鮮豔，由此可知其焦慮已顯著降低，最後成功地釋放其住院壓力及明顯改善退化性行為，發現不同時間點的圖畫可看出情緒感受的波動變化，於是筆者根據其個別照護需求來適時提供介入措施，並透過建立正向的自我心像來提升自信心及自我價值感。兒童投射性繪畫及其敘述可提供獨特的視窗來透視其內在經驗，運用繪畫協助兒童將複雜的感覺外在化，不僅提供兒科護理人員另一層次評估兒童內在感受的媒介，亦能賦予住院兒童更人性化的照護，達成雙贏的局面。投射性繪畫具有臨床使用價值，值得在臨床兒科護理加以應用。Hospitalization is very stressful for children. Some hospitalized children show regressive behaviors in response to various treatments and examination procedures. This article describes the use of projective technique of drawing to assist a school-aged child with Langerhans cell histiocytosis to adapt to her body image changes. The author collected data by participant observation and individual interviews. After the evaluation, nursing problems, 'body image change' and 'regressive behaviors' such as nocturia and crying at midnight were identified. First, the author established mutual trust in the relationship with the child by drawing, and further encouraged the child to express her feelings about the operation and body image change through drawing. The author applied projective technique of drawing to focus on adaptation of the child’s body image change. The major colors of her drawings in initial hospitalization were red and black possibly because of the psychological projection of worry and pain. Later the composition of her pictures was vivid and colorful. We found her anxiety was then obviously reduced. Finally, the technique released stress of hospitalization successfully and showed significant improvement in regressive behavior. The drawings in different time period showed fluctuation of emotion. The authors implemented nursing interventions focusing on individualized caring needs, self-confidence boost and self-value by establishing positive self-image. The technique of projective drawings and narratives is a unique window into children's inner experiences. Drawing could help children to externalize complicated feelings inside. It could provide not only pediatric nurses another media of effective assessment of inner perception, but also more humanistic care to hospitalized children, creating a win-win situation. This suggests that projective drawing has clinical value and is worthy of clinical application in pediatric nursing.