運用治療性遊戲及虛擬實境機減輕燙傷兒童疼痛之照護經驗

Nursing Experience in Relieving pain of a Scalded Child Using Therapeutic Games and Virtual Reality Machines

本文描述一位學齡前期燙傷兒童運用治療性遊戲及虛擬實境機減輕疼痛之護理經驗。筆者於2021年2月3至2月7日照護期間，以羅氏適應模式評估作為指引，經身體評估、會談及運用治療性遊戲與其溝通來收集資料，確立個案有急性疼痛、皮膚完整性受損及照顧者角色緊張等健康問題。護理過程中，個案因換藥疼痛而有抗拒治療及住院壓力產生，進而影響案母有擔憂及焦慮情形。故選此個案，希望介入治療性遊戲，如：角色扮演、繪本導讀、獎勵等方式，幫助表達內心恐懼，使其了解換藥的重要性進而配合治療；針對傷口疼痛部分，除藥物控制外更利用虛擬實境機搭配遊戲影片，減輕疼痛感知與焦慮感受；照護期間以同理心陪伴案母，並鼓勵案母參與照護以了解病情，提供疾病相關照護知識，利用仿真嬰兒讓案母練習換藥步驟，提昇照護因應能力來維持家庭功能運作，使個案出院後亦能享有一致且連續性的照護。臨床研究顯示，虛擬實境機不僅可減輕疼痛，還能降低焦慮情形，經由此次照護經驗後更印證其效用，是為更人性化及趣味性的減痛方式，對疼痛病童來說將是一大福音，期許此次經驗分享能給同仁作為減痛補充療法之參考。

This study describes the nursing care provided to a scalded preschool child, where therapeutic games and virtual reality machines were used to reduce pain. Care was provided from February 3 to 7, 2021, and Roy’s adaptation model was used for assessment. Data were collected through physical assessments, interviews, and therapeutic games that facilitated communication with the patient. The child was found to have health issues such as acute pain and impaired skin integrity, and caregiver role strain was also identified. Throughout the nursing process, the patient resisted treatment and experienced stress from hospitalization owing to the pain of dressing changes, which increased worries and anxiety in the mother. Therefore, the patient was selected for intervention using therapeutic games including role-playing, picture book reading, and rewards to assist them in expressing inner fears and understanding the importance of burn dressing changes, leading to improved cooperation with the treatment. Besides medication for pain control, a virtual reality machine with game videos was also used to alleviate pain perception and anxiety. During the care process, the patient’s mother was supported empathetically and encouraged to participate to enhance her understanding of the child’s condition. She was also provided with information on symptom-related care and trained in dressing change procedures using an infant manikin to enhance her skills in nursing response and maintain family function. This approach ensured consistent and continuous care for the patient post-discharge. Clinical studies have established that virtual reality machines are effective in reducing pain and alleviating anxiety. This care experience confirms their effectiveness, and presents a more humane and engaging approach to pain relief in children. Thus, the results are shared as a potential supplementary therapy for reference by colleagues.