應用繪本了解一位入住兒童加護病房學齡孩童壓力之護理經驗

Understanding a Hospitalized, School-Aged Child's Stress in the PICU: The Application of Picture Books in Nursing Care

當孩童遭遇創傷或疾病威脅而住院治療，隨之而來的疾病痛楚、醫療處置及陌生環境，對孩童帶來巨大的身心影響。筆者擔任主要照護護理師，透過觀察一位學齡期孩童住加護病房的壓力反應，藉由與個案會談及互動以蒐集資料，評估及解析其心理情緒、行為反應以及情感表達方式，並擬定漸進性護理措施。首先提供個案選擇權和建立目標性的生活計畫來強化自主和控制感，接著藉由陪伴方式與個案逐漸建立信任感，進一步以繪本閱讀引導個案情緒宣洩，表達渴望家人關愛與陪伴的需求。藉此案例分享，希望提升臨床護理人員對於孩童需求和心理感受之重視，協助宣洩、調適住院壓力。

Hospitalization in the pediatric intensive care unit (PICU) can be a very stressful and sometimes traumatic experience for school-aged children due to illness, painful procedures, unfamiliar environment, and separation from family. We incorporated picture books into PICU nursing care to explore the stress response in a school-aged child with compartment syndrome who was hospitalized in the PICU. Observation, interview and communication with the patient were used to assess her psychological reactions and emotional and behavioral responses to stress related to hospitalization and medical treatment. Autonomy and control were provided and strengthened by giving the patient choices and purposive life plans. Picture books were used to establish rapport and help the patient express her feelings, needs, and desires for parental love and company. This case report highlights the importance of nurses' awareness of children's stresses and needs during hospitalization in the PICU as well as the value of picture books or other age-appropriate tools for this patient population.