運用治療性遊戲緩解自閉症類群障礙的學齡前兒童住院壓力之照護經驗

Nursing Experience of Reducing an Autism Spectrum Disorder Preschooler 's Hospitalization Stress through Therapeutic Play

本文描述運用治療性遊戲緩解自閉症類群障礙的學齡前兒童住院壓力之照護經驗。照護期間為2018年10月20日至10月26日，運用紐曼系統模式進行評估，並以觀察、會談等方式收集資料，確立健康問題為體溫過高、恐懼及照顧者角色緊張。在照護過程中，個案因疾病產生不適症狀、不熟悉醫療處置及醫護人員的多重壓力而焦慮不安，出現情緒及行為失調，故筆者配合學齡前兒童的認知發展，藉由個案喜愛的玩偶進行角色扮演及醫療型玩具進行治療性遊戲，鼓勵表達其內在的情緒感受，適時給予正增強獎勵策略，進而增進護病信任關係與互動，提昇對治療的正向經驗，並提供主要照顧者照護資訊，關注於其所在意的問題，解決疑慮，進而增加在照護上的信心。建議臨床護理同仁在照護自閉症類群障礙兒童時可多使用治療性遊戲與之互動，以提升病童之遵從性而增進健康。

This article described the nursing experience of applying therapeutic play to reduce hospitalization stress for a preschooler with autism spectrum disorder. Neuman's System Model was used to assess, develop, and evaluate issues and solutions in nursing care. Data were collected through interviews and observations during the period of 20-26 October 2018. The patient’s health issues include hyperthermia, fear, and caregiver role strain. During the nursing process, the author discovered an increase of the patient's defense and retreat behaviors, and fear of unfamiliar environments and unknown situations due to physical discomfort. Therefore, by following the cognitive development stages in the preschool years, the author applied the therapeutic play with role play of dolls, clinic equipment set toy, and positive reinforcement strategies to encourage emotional expression, and build the trust relations with the patient. Through therapeutic play, children can acquire opportunities to express themselves and deal with stress related to health experiences. Furthermore, the primary caregiver was provided with appropriate knowledge about the disease and its nursing techniques to address her concerns, thereby increasing the confidence and the ability of the primary caregiver. We suggested that the nurses may consider employing play as a means to communicate with patients with autism spectrum disorder. Therapeutic play may also improve patient compliance with the process of nursing, leading to successful recovery.