治療性遊戲於Guillian-Barre症候群病童護理之運用

Nursing Experience of Therapeutic Play to a Child with Guillian-Barre Syndrome

本篇個案報告運用治療性遊戲於一位學齡期兒童患Guillian-Barre症候群的護理過程。筆者於94年3月31日至94年4月10日間藉由觀察、身體評估、半結構性會談及運用Gordon十一項健康功能型態，評估個案生理及心理的需要，收集相關資料加以整理分析並確立護理問題。在護理過程中發現個案因Guillian-Barre症候群導致肌肉麻痺、呼吸困難，須執行氣管內管留置來協助呼吸，使個案因有氣管內管不能發聲求助，而出現恐懼、無助之行為，因此歸納出個案主要的護理問題有：(一)呼吸道清除功能失效；(二)身體活動障礙；(三)言語溝通障礙；(四)恐懼；(五)疼痛。筆者藉由治療性遊戲與個案建立信任關係，並以“大象清鼻孔”的故事來協助個案維持氣管內管呼吸道之通暢；針對身體活動功能障礙所產生言語溝通困難之問題，筆者設計鈴鐺掛在手上當叫人鈴；利用圖卡及鏡子，增進與個案的溝通，適時地運用遊戲作引導個案表達心中的感受，減低個案住院治療之恐懼；以愛心及同理心與個案建立良好的護病關係，使個案因疾病住院產生之恐懼憤怒轉為積極的參與護理計畫活動，循序漸進解決個案的護理問題，而使病情獲得改善。

This case report was about the nursing course of using therapeutic games in a school-age childwith Guillian-Barre Syndrome. The author assessed the physiological and psychologicalrequirements of the case and collected correlation data to establish the nursing item by clinicalobservation, physical examination, interview andGordon's 11-item health assessment verificationbetween March 31 and April 10, 2005. The patient suffered from muscle paralysis andsubsequently respiratory difficulty, and received endotracheal tube intubation with mechanismventilator support. He felt fearful and helpless for poor communication. We listed the patient'snursing problems as follows: (1)Impaired ability of airway clearance, (2)Limited body motion, (3)Impaired vocal communication, (4)Fear and (5)Pain. The author built up relationship with thepatient by therapeutic games, using the story of 'The Elephant Clearing Nostril ' to assist thepatient keeping airway free.We also utilized hand-ball, picture cards, mirror, and VCD to improvecommunication with the patient. Therefore the fear and nursing problems during hospitalizationwere solved. Pediatric nurses may consider employing play as a part of therapy to reduce theirstress during hospitalization. Therapeutic play may also improve patients'compliance of nursingprocess.