運用治療性遊戲於一位學齡期兒童撕裂傷縫合之急診護理經驗

An Emergency Nursing Experience of Applying Therapeutic Play to a School-Age Child Undergoing Suturing of Laceration

本文旨在探討運用治療性遊戲幫助一位7歲學齡期病童，接受撕裂傷縫合的急診護理經驗。護理期間為2014年11月07日12:30至13:15，以兒童生理、發展、就醫壓力與家庭評估為評估架構，透過身體評估、觀察、溝通、病歷閱覽等方式收集資料，確立病童有組織完整性受損、焦慮之健康問題。病童因為對額頭撕裂傷縫合感到害怕、焦慮，出現畏縮、哭鬧、拒絕縫合等反應，筆者利用治療性遊戲方式使其了解縫合過程、減少對未知的恐懼、激發勇氣、鼓勵其接受縫合治療；縫合過程中透過進度講解、緊握雙手、口頭鼓勵、引導數數字轉移注意力與增進安全感，幫助其順利完成縫合。基於本照護經驗，建議急診醫護人員應該培養治療性遊戲的能力，以提供兒童最佳的急診就醫品質。

This paper describes an emergency nursing experience of applying therapeutic play to assist a 7-year-old school age pediatric patient during the suturing of laceration. The nursing period lasted from 12:30 to 13:15 on November 7, 2014. With pediatric physiology and development, hospitalization stress, and family evaluation as an assessment framework, data were collected via physical evaluation, observation, conversation, and chart review. The patient was identified with impaired tissue integrity and anxiety. During the suturing of forehead laceration, the pediatric patient exhibited fear, anxiety, and displayed reactions such as flinching, crying, screaming, and refusal to undergo suturing. We applied therapeutic play to help the patient to overcome the fear of unknown by understand the suturing process, to inspire courage, and to encourage the patient to receive suturing. During the suturing process, we applied interventions including progress explanation, hand holding, verbal encouragement, shifting attention by number-counting, and instilling a sense of security to aid the completion of the suturing. Based on this nursing experience, we would like to recommend emergency nurses to develop capabilities to engage in therapeutic play to provide children with highest quality of emergency care.