運用治療性遊戲協助一位學齡前期白血病兒童降低Port-A 人工血管扎針之恐懼

Applying Therapeutic Play to Assist a Preschool Child with Leukemia to Reduce the Fear of Port-A Insertion

本文運用治療性遊戲協助一位急性淋巴性白血病之學齡前期兒童降低對Port-A扎針之恐懼。由於個案相當害怕Port-A扎針，每次都會出現大聲哭鬧且恐懼不安的行為反應，案母只能緊抓他來接受扎針。因此筆者結合「情緒宣洩性遊戲」與「指導性遊戲」之治療性遊戲種類來設計，考量學齡前期兒童的發展特色及個案所喜愛的卡通人物，遊戲主題是「柯博文與憤怒鳥的傳奇」，以英雄柯博文需要從Port-A輸送能量，有四種轉移注意力的方式，利用部分真實的醫療用品進行角色模擬，自製Port-A注射點滴道具組讓個案熟悉處置流程。四種轉移注意力的道具法寶，包括：憤怒鳥吹吹排笛（用吸管製成，有音階可吹氣）、憤怒鳥數數板（數板子上的憤怒鳥或分類）、太空風鈴（拉繩放手反彈會發出鈴噹聲）和小壞蛋（扎針同時捏軟球），藉此抒發情緒及轉移注意力，並搭配指導Port-A扎針之處置流程。案母也學會運用英雄故事當作個案的角色模範來安撫個案，讓個案覺得自己也是英雄，意識到要勇敢。此次治療性遊戲針對個案的需求及興趣，達成降低恐懼、抒發情緒及轉移注意力之成效。假如能秉持「無創傷性照護」之原則，適當運用治療性遊戲來協助個案降低Port-A扎針的恐懼，將能使心理創傷減至最低，並落實「兒童友善醫療照護」。

This case study describes the use of therapeutic play to help a preschool child with acute lymphoblastic leukemia to reduce fear of Port-A insertion. Due to the specific fear of Port-A insertion, he appeared behavioral responses like crying loudly and fearful reaction, therefore the mother could not help but clutch him to accept Port-A insertion every time. We took preschooler’s developmental features and favorite cartoon characters into consideration and combined various types of therapeutic play, including “emotional outlet play” and “instructional play”, the theme of the play was chosen as “Legend of Optimus Prime and the Angry Birds”. To be brief, the whole instructions indicated Hero Optimus Prime needed to transport energy from Port-A. On the perspective of atraumatic care, several kinds of real medical supplies and handmade Port-A intravenous drip prop would be used to ease the client at the same time and helped the client adapting. The project comprises four ways to divert attention, including Angry Birds Blow Panpipe (made with plastic straws and it worked as a simple music instrument), Angry Birds Counting Board (count how many angry birds there are on the board and divide them into groups), Space Campanula (pull the rope and bell rings), and Little Bad Egg (young client can hold and squeeze them while injected), hence the client could express emotion and divert attention, with the guidance of the procedure of the Port-A insertion. His mother also learned how to act in the hero stories as a role model to pacify the child that he was a hero to be brave. This therapeutic play focused on the client’s needs and interests to attain the effectiveness of reducing fear, expressing emotion and distraction. If we could uphold the principles of “atraumatic care” and use of therapeutic play appropriately to assist the child to reduce the fear of Port-A insertion, psychological trauma will be minimized, the “child-friendly healthcare” will be implemented.