運用治療性遊戲於一位罹患噬血症候群學齡前期兒童之加護照顧經驗

The Use of Therapeutic Play in the Intensive Care of a Preschool Child With Virus-Associated Hemophagocytic Syndrome

住院對兒童極具壓力、容易造成兒童焦慮、恐懼，因而反抗、不願配合，導致治療的延誤。因此，運用符合兒童發展年齡之護理措施以協助兒童調適住院壓力並配合醫療，是照護的重點。本文描述筆者於2012年11月13日至2012年11月19日運用治療性遊戲照護一位因病毒相關噬血症候群住加護病房之學齡前期兒童的護理經驗。筆者藉由觀察、與個案互動，收集、評估並分析個案之住院壓力反應，並擬定符合其發展階段之護理措施。個案由於「與主要照護者分離」、「對醫療環境與器材之陌生、害怕」、「不了解治療與服藥目的、對服用苦澀藥物產生恐懼」、「喪失控制與自主權」，產生住院壓力反應，於治療介入時出現哭泣、大叫、拒絕觸碰、要求父母陪伴等行為。筆者運用學齡前期對自主的發展需求，融入繪畫、醫療繪本做為溝通策略，了解個案行為反應之原因及其內心感受，提供情緒宣洩之管道，並利用遊戲傳遞治療目的，成功協助個案調適住院壓力並順利接受治療。

Hospitalization is a stressful experience for children that increases their anxiety and fears, generates resistance and noncompliance, and, as a result, delays necessary treatments. Developing an age-appropriate intervention to reduce the hospitalization-related stress perceived by children is an important component of pediatric nursing. This case study used therapeutic play and drawing to care for a virus-associated hemophagocytic syndrome preschooler who stayed in our pediatric intensive care unit (PICU) between 11/13/2012 and 11/19/2012. Stressors faced by the patient included separation from primary caregiver, unfamiliarity with the medical environment and equipment, non-comprehension of the treatment and medication regimens, and loss of control. The patient displayed incorporative behaviors such as crying, screaming, refusing to be touched, and requesting parental accompaniment. Painting and picture books were used as developmentally appropriate interventions to understand the patient's feelings and to provide a means for him to project and release emotions. This strategy successfully assisted the child to overcome the perceived stress of hospitalization and to cooperate with healthcare providers on his treatment.