運用治療性遊戲於學齡前期細支氣管炎兒童之護理經驗

The Nursing Experience of Caring by Using Therapeutic Play for a Preschool Child with Bronchiolitis

本文主要探討一位學齡前期兒童因細支氣管炎住院之護理經驗，護理期間為2021年3月29日至2021年4月2日，採用Gordon十一項功能性健康型態評估工具，以查閱病歷、直接照護、身體評估、觀察及非結構性會談等方式進行整體性評估，確定個案有體溫過高、呼吸道清除功能失效、照顧者角色緊張等護理問題。本文個案係第一次住院，面對陌生的醫療環境及處置表現出抗拒及無法配合，筆者針對個案對噴霧治療及胸部扣擊的恐懼，設計適合的治療性遊戲工具，使個案願意配合。案母則因個案住院，進而懷疑起自己是否無法勝任照顧個案，甚至到了不敢上床休息的地步。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照護上的角色功能，對於照護過程中不足之處，給予淺顯易懂的說明，以鼓勵的方式陳述其漸進的進步之處，增加其照護信心。護理過程中發現個案的喜好及護理師所受過治療性遊戲訓練皆會影響治療性遊戲的介入，建議院方可製作數種動物款式外殼噴霧治療器具，以提升病人的配合度，也同步提升護理師在進行臨床處置上的滿意度。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 hospitalized with bronchiolitis from March 29 to April 2, 2021. Holistic assessment through review of medical records, direct care, physical assessment, observation, and unstructured interviews by using Gordon's 11 Functional Health Patterns assessment. established nursing problems include: hyperthermia, Ineffective airway clearance and caregiver role strain. This case is the first time to be hospitalized. To resist and unable to cooperate in the face of unfamiliar medical environment and treatment. According to the case's fear of aerosol treatment and chest punching, the author designed suitable therapeutic game tools to make the case willing to cooperate. The mother of the child was hospitalized due to the case, and then doubted whether she was competent to take care of the case, and even dared not go to bed. The author uses the attitude of acceptance, listening and non-judgment to make the mother face up to her role in child care. For the deficiencies in the nursing process, give easyto- understand explanations, and state their gradual progress in an encouraging way to increase their confidence in nursing. During this nursing process was found that both the preference of the case and the therapeutic play training received by the nurse will affect the intervention of therapeutic play. It is suggested that the hospital can produce several types of animal-style shell aerosol treatment equipment to improve the cooperation of patients and simultaneously improve the satisfaction of nurses in clinical treatment. It is expected that this nursing care experience contributes to providing clinical information for those who care similar cases.