運用治療性遊戲於一位學齡前期肺炎兒童之護理經驗

A Nursing Care Experience of a Preschooler with Pneumonia Based on Therapeutic Play

本文主要探討一位學齡前期因肺炎住院治療的護理經驗。照護期間為2019年4月10日至2019年4月15日，藉由直接照護、身體評估、觀察、溝通會談等方式，運用Gordon十一項功能性健康型態評估收集與分析資料，確認個案有呼吸道清除功能失效、恐懼、照顧者角色緊張等護理問題。本文個案係第四次住院，在面對陌生的醫療人員、環境、醫療處置仍舊表現出明顯的恐懼及無法配合，筆者針對個案對噴霧治療設備的恐懼配合個案所喜愛的蒸汽火車，製作治療性遊戲工具，運用於個案噴霧治療，使個案得以願意配合。且案母則因個案多次入院，對於護理指導的吸收及表達顯得較畏縮，筆者藉由接納、傾聽與不批判的態度使案母正視自己對於兒童的照護應是協助兒童發展出良好的獨立性，並非是扮演完美母親的角色，藉此增加案母在照顧能力上的自信心。在此次照護經驗裡，發現臨床護理人員在護理指導的內容不一致，故建議增設噴霧治療護理指導單張，使臨床護理指導達一致性。期望藉此護理經驗，提供護理同仁日後照顧此類個案之參考。

This study aims to explore a nursing care experience of a preschooler with Pneumonia using therapeutic play from April 10 to April 15, 2019. Direct care, physical evaluation, observation and interviews were performed. Data were collected and analyzed based on Gordon 11 Function Health Patterns, and findings included the client's failure of respiratory tract cleaning function, the client's fear due to facing strange environment and medical management during hospitalization and care-giver's role strain. This client demonstrated fear and was not able to cooperate while facing the medical team, environment and medical management. A tailor-made therapeutic toy, the client's favorite steam train, was used while performing aerosol therapy, so the client was able to engage in the treatment. The care-giver showed unconfident when receiving nursing instruction. The author listened and encouraged the care-giver to positively help the client to develop independence. Instead of playing a role of a perfect mother, the care-giver demonstrated more confidence in caring skills. Inconsistency in nursing instruction was found in this caring experience, so it is suggested that instruction leaflet regarding aerosol therapy was added. It is expected that this nursing care experience contributes to providing clinical information for those who care similar cases.