運用治療性遊戲照顧一位腸病毒幼兒之護理經驗

Nursing Experien ces of Applying Therapeutic Play Caring with Ente rovirus Young Child

腸病毒好發9 歲以下兒童，而3 歲以下幼童更是感染腸病毒重症的高危險群，本個案為2 歲5 個月初次住院之腸病毒幼兒，住院期間因疾病及陌生環境造成心理上 衝擊，經常以哭鬧和抗拒治療等行為表達不滿，又因為發燒、口腔疼痛、食慾差等問題，讓個案母親產生緊張情緒，且擔心個案是否為重症患者，故引發筆者想應用治療 性遊戲於個案護理措施中。護理期間自2017 年9 月13 日至2017 年9 月18 日，筆者藉Gordon 十ㄧ項健康功能評估，以觀察、會談、圖片及傾聽等方式對個案進行整體性評估，發現個案及主要照顧者健康問題包括體溫過高、疼痛、無效性健康維護能 力。首先與個案建立護病關係，提供腸病毒發燒護理措施，並選擇適合該年齡層的治療性遊戲，做為口腔粘膜疼痛照護內容的媒介。其次，藉由治療性遊戲減緩個案對進 食和口腔照護的害怕，並增加其對腸病毒治療的接受度。再者，透過持續地傾聽、同理和關懷，提供照顧者支持性環境，使個案和照顧者能適時地表達內心想法，也降低 兩者的不安。最後，協助個案康復出院，也提供照顧者出院準備計畫。建議兒科醫護人員可學習將治療性遊戲融入於孩童住院照護過程中，使病童能順利地進行治療，成 為病童與照顧者住院期間緩解壓力的媒介，達到提升照護品質的目標。

 

Enterovirus is common for young children under 9 years old and the high risk population for contacting serious enterovirus is young children below 3 years old. This case was a 2 year 5 month old child who had psychological shock due to illness and a strange environment. The child expressed dissatisfaction through the behaviors of frequent crying and resisting treatments during hospitalization. Additionally, the fever, oral pain, and poor appetite problems caused the case’s mother to have anxiety. Therefore, the author was inspired to apply therapeutic play into the nursing care. Gordon 11 health function assessment was used, including observation, interview, photos, and listening methods to comprehensively assess the case during the nursing period from 2017.9.13. to 2017.9.18. Three health problems were identified, including hyper temperature, pain, and ineffective health maintaining ability. Initially the author developed the nursepatient relationship to provide Enterovirus fever nursing interventions. Secondly, the therapeutic play was designed according to the case’s age as the medium of oral mucosa pain care content. Additionally, the fears of oral eating and oral care were alleviated and acceptance of the enterovirus treatment was increased through therapeutic play. Furthermore, the case and caregiver were able to express the inner thoughts appropriately and their disturbance was decreased through consistent care, listening, and empathy provided in the caregiver’s support environment. Finally, the case recovered and was discharged with a discharge planning provided for the caregiver. The author suggests that pediatric medical and nursing staff learn to merge therapeutic play methods into the care process for hospitalized children. In doing so, sick children and caregivers can conduct treatment easily as they intervene to alleviate stress during hospitalization, and approach the goal of promoting the quality of care.