運用治療性遊戲於學齡前期病童的護理過程

Application of Therapeutic Play in the Process of Nursing a Preschool Patient

本文係運用治療性遊戲於一位年僅四歲且患有腸阻塞病童的護理過程。病童左鎖骨下有一Port-A，右上腹部有一迴腸造口，每次換藥時總是大哭及身體抗拒厲害，在住院期間常有哭泣及不合作的情形發生。藉由參與觀察方式收集並分析幼兒的住院行為。結果發現病童有預期性疼痛、身體心像問題、情緒宣洩管道欠缺等護理問題，因此筆者就（1）信任感的建立、（2）降低對治療的恐懼、（3）了解其自我心像的感受、（4）情緒的宣洩等四個方向進行治療性遊戲，過程中成功地改善病童預期性疼痛哭泣及不合作的情形，亦得知其對於自我身體心像的想法，並提供一個情緒發洩及轉移注意力的管道。筆者在此護理過程中深刻體會到「孩兒玩」的自然天性，護理人員應適時地運用遊戲作為溝通方式，將有助於紓解病童的住院壓力並增加對治療之遵從度。

This report describes the application of therapeutic play to a 4-year-old female patient with intestinal obstruction during the process of nursing. The patient suffered a Port-A in the clavicle and an ileostomy in the right upper abdomen. She cried incessantly and resisted nurses who attempted to change her dressing. Data were collected by participant observation, and it was found that the patient had problems dealing with anticipatory pain and body image and lacked an emotional outlet. Therapeutic play therefore was applied during the process of nursing in an effort to accomplish the following: (1) establish trust between the patient and the health care providers; (2) reduce the patient's fear of therapy; (3) help the patient to understand her own self-image; (4) provide an emotional outlet for her. During the nursing process, we improved her overall compliance, provided her with an emotional outlet, and helped her to understand her self-image. Through this nursing process we experienced the nature of children's play. Pediatric nurses may consider employing play as a means to communicate with patients in an effort to reduce their stress during hospitalization. Therapeutic play may also improve patient compliance with the process of nursing.