運用治療性遊戲照護一位受虐兒童在急診之護理經驗

The Utilization of Therapeutic Play to an Abused Child in the Emergency Department Nursing Care Experience

本文運用治療性遊戲照護一位學齡期兒童遭受父親虐待於急診之護理經驗。首先利用遊戲與個案建立治療性信任關係，藉由直接觀察、身體評估、角色扮演、繪畫引導等方式，從遊戲中了解個案所遭受虐待之恐懼及內心情緒。同時在遊戲中得知個案於急診留觀期間面臨與母親分離焦慮，易對人產生不信任、不易與人親近、拒絕換藥等，故運用治療性遊戲中的布偶角色扮演、繪畫等象徵性及投射性遊戲溝通技巧，引導個案說出內心感受及情緒壓力之宣洩。個案在遊戲治療後由被動轉變為主動與主護護理師有信任互動關係，願意接受換藥治療，並順利達成個案與主護護理師的溝通橋樑及提升對治療的順從性。因此深感遭受暴力的兒童身心受創是嚴重的，是需要護理人員去支持；若護理人員能持有「無創傷性照護」理念，適當運用治療性遊戲來協助了解受虐兒童心理受創及身理傷痛，使個案創傷減至最低及得到完善的照護，早日脫離受虐的夢魘。

In this article, uses a therapeutic play theory as a framework in the emergency nursing care experience, to care a school-age child who has been abused by his father. First, uses the game to establish therapeutic relationship of trust with the child. By the method of direct observation, physical assessment, role-playing, painting guidance, we can understand from the game the fear and inner emotions of the abused child.At the same time in the game that cases facing separation anxiety with his mother in the emergency observation period, easy to distrust people, is not easy with people close to refuse medication, etc.; so I use therapeutic play puppet role-playing, painting, etc.the symbolic projection game communication skills, guide cases to express feelings and emotional stress catharsis. From passive into active cases in the game after treatment with interaction between trust, and are willing to accept a dressing treatment, and successfully reached the cases, and of a bridge and enhance treatment adherence. Therefore, the author think it is a serious damage of physical and mental condition for abused child. And they all need nursing staff to support them. If nursing staff can have the concept of “Non-traurnatic Care” and properly apply the therapeutic play to understand the Psychological and physical trauma of abused child. Then we can minimize the damage of the abused child and make them to get perfect care to escape the nightmare of been-abused early.