運用治療性遊戲於一位學齡前期氣喘兒童之護理經驗

A Nursing Care Experience of a Pre-school Child with Asthma Based on Therapeutic Play Therapy

本文係運用治療性遊戲於一位學齡前期氣喘兒童之護理經驗，護理期間為2019年12月15日至2019年12月18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：（1）低效性呼吸型態∕與氣道阻塞或分泌物增加有關；（2）恐懼∕與住院面對陌生環境及醫療處置有關；（3）照顧者角色緊張∕與個案短時間再次入院及自我懷疑照顧能力不足有關。本文個案因曾入住加護病房因而與案母分離，且住院過程中必須面對不熟悉甚至會產生疼痛的醫療處置，對於個案造成莫大的恐懼，個案出現了閃躲、抗拒的行為無法配合護理活動，故引發筆者動機，針對學齡前期病童出現的治療抗拒行為，擬訂了治療性遊戲計畫，以緩解個案的恐懼，並邀請案母一同參與，藉由溝通實作的過程提升案母照顧的自信。鑒於個案有多位居家照顧者，考量氣喘誘發與二手菸及環境有很大的關係，建議安排定期回診時，家屬能提供居家環境影片或照片，護理人員可協助評估並給予適用的環境改善衛教，使家長們能有一致的照顧共識，以期降低疾病復發。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 described a nursing care experience of a pre-school child with Asthma based on therapeutic play therapy from December 15 to 18, 2019. Gordon's 11 Functional Health Patterns Assessment, direct care, physical evaluation, observation and interviews were conducted to collect data and identify problems, including (1) ineffective breathing patterns due to airway obstruction or increased discharge, (2) fear due to face strange environment and medical management during hospitalization, (3) caregiver's role strain due to quick readmission of the child and her unconfident of caring skills. This client was separated from the caregiver during hospitalization in ICU, resulting in great fear while receiving medical treatment. The client avoided and resisted to cooperate any nursing activity. The author was motivated to design therapeutic plays to relieve the fear of the client. The caregiver was invited to participate in the hope that she was able to increase her caring confidence. Secondhand smoking and environment were highly suspected to induce the client's Asthma, so the family members were required to provide home video or pictures while returning to the hospital. The nursing professionals were able to assess and provide improving suggestions, so the caregivers reached the consensus and reduce recurrence of Asthma. It is expected that this study provide a reference for nursing professionals who care similar cases.