運用治療性遊戲於腸沾黏分離術後幼兒及出院準備之經驗

Experience of Applying Therapeutic Games to a Toddler after Enterolysis Surgery and Discharge Preparation

本文描述一位幼兒行腸沾黏分離術後及進行出院準備之護理經驗，照護期間自2019年4月23日至2019年5月5日，以羅氏適應模式為評估指引，筆者藉由照護、觀察、身體評估、會談及病歷資料查詢等方式進行資料收集，確立健康問題有：急性疼痛、潛在危險性感染；此外，發現案母面對個案術後傷口照護及擔憂返家照護不易，而有照顧者角色緊張之護理問題。護理過程中，個案因術後疼痛不適加上頻繁的治療活動，常有哭鬧、抗拒情形發生，亦加成家屬不安及焦慮，引發筆者想以治療性遊戲模式介入進行深入探討，照護期間除了提供基本生理性照護以預防術後感染情形外，更設計符合其認知及發展特質的治療性遊戲，如兔子醫師及痛痛熊的角色扮演、轉移注意力、敲打型的情緒宣洩性遊戲，來緩解個案術後疼痛及住院壓力；針對出院準備部分，初期鼓勵家庭成員參與遊戲照護過程以緩解無助感與照護壓力，運用嬰兒模型請家屬實際進行換藥練習，教導其觀察術後感染症狀、返家照護技巧及注意事項等，提升家庭因應能力及凝聚力，進而提升居家照護品質，協助達成適應且健康的狀態。兒科護理當中，治療性遊戲是獨特且具人性化的照護核心要素，故期望藉此經驗分享，提供同仁臨床照護類似個案之參考。

This paper describes the nursing experience of a toddler after enterolysis surgery and discharge preparation. The nursing period extended from April 23, 2019 to May 5, 2019. Keeping the Roy Adaptation Model as the evaluation guide, data were collected by means of care, observation, physical assessment, interviews, and a review of medical records. The patient's health problems were determined to be acute pain and a potentially dangerous infection. In addition, it was found that the patient's mother suffered from caregiver stress when faced with the difficult task of taking care of the patient's wound after surgery; she worried that taking care of the patient after returning home would not be easy. During the nursing care process, the patient often cried and resisted care due to postoperative pain and frequent treatments, which also added to the worry and anxiety of the family members. For this reason, we aimed to investigatie the effect of therapeutic games intervention have on the toddler. During the nursing period, in addition to providing basic physiological care, therapeutic games, in line with the patient's cognitive and developmental characteristics were designed. These included role-playing and percussion emotional catharsis games to relieve the patient's postoperative discomfort and the pressure caused by hospitalization. For discharge preparation, family members were encouraged to participate in the game care process to relieve their feelings of helplessness and care pressure. Baby models were used to guide the family members to practice dressing change and to teach them how to observe for symptoms of postoperative infection as well as care skills and the precautions to be taken after returning home. This was done to improve the coping ability of the family and to enhance the quality of home care, and thus assist in achieving an adaptive and healthy state. In pediatric nursing, therapeutic games are a unique and humane core element of nursing. It is hoped that the experience shared here is useful for peers working in the clinical care of similar cases.