運用治療性遊戲照護一位初次診斷第一型糖尿病病童之護理經驗

A Nursing Experience of Applying Therapeutic Play to a School-Age Child Receiving the First Diagnosis of Type I Diabetes Mellitus

本文主要在描述一位初次診斷第一型糖尿病的學齡期兒童護理經驗，描述於初診斷期間，因醫療資訊不足下，病童及家長有許多不瞭解及擔憂，而無法順利配合血糖控制治療計畫，筆者於2018年3月14至3月21日護理期間運用Gordon十一項功能評估作為評估指引，透過會談、觀察及病歷查閱確立有1.潛在危險性血糖濃度不穩定／與初診斷第一型糖尿病及家長疾病管理知識不足有關、2.恐懼／與害怕血糖測量及胰島素注射有關、3.照顧者角色緊張／與擔心未來病程進展及無有效疾病管理能力有關等問題。考量兒童於各年齡認知程度及特徵的不同，在與個案建立治療性人際關係後，舉辦以家庭為中心的第一型糖尿病衛教活動，融入治療性遊戲及模擬情境影片，促進病童及照顧者學會第一型糖尿病相關照護知識與自我血糖監測技能（Self Blood Glucose Monitoring，SBGM），並且提供心理支持，促進正向接受罹病及鼓勵家長重新認識兒童生長發育與疾病之慢性化，建立返家計畫，加快血糖穩定出院及恢復家庭生活正常化。建議兒科護理人員照護T1DM病童時，若能配合糖尿病衛教師及營養師進行護理指導，賦權學齡病童於自我照顧中的選擇權，如飲食安排或食物代換選擇，使其參與度及配合度增加，達到良性自主控制目的，以提升糖尿病病童的護理品質。

This article described the nursing experience of caring a school-age child diagnosed with type 1 diabetes the first time. During the hospitalization period, because of the lack of knowledge and an uncertainty in diabetic control, the patient and her family faced had concerns and anxiety. Therefore, the child and caregivers could not successfully engage in the treatment plan. From March 14 to 21, 2018, the Gordon 11 Function Health Patterns were used for a comprehensive assessment. Information on patient’s health condition and needs were collected through direct observation, interviews, and chart review.. The child’s health problems included risk for unstable blood glucose level, fear of blood glucose measurement and insulin injection, and caregiver role strain. The cognitive development and characteristics of each child are different. After establishing the therapeutic relationship, a family-centered care plan was introduced to promote the understanding of the etiology and pathology progress of T1DM, and an individual therapeutic play with simulated situation was designed. The child and caregivers were the key persons invited to join the daily care with diet management, and insulin injection or Self Blood Glucose Monitoring. The patient and her family were encouraged to express emotions and the frustration of dealing with blood sugar control. The normalization of the family process is important, and pediatric nurses need to help the family. When facing T1DM children, ward nurses, certified diabetes educators, and nutritionists who major in DM children care are necessary to provide clear nursing guidance, such as food conversion tables. By following these guidelines, an empowerment in self- care and the quality of life will become easier for type 1 diabetic children.