一位失禁性皮膚炎幼童之照護經驗

The Experience of Caring for a Child Suffering From Incontinent Dermatitis

10.6224/JN.000090

盧虹如(Hong-Ru Lu)；陳詠如(Yung-Ju Chen)；柯雅芳(Ya-Fang Ko)

失禁性皮膚炎 ； 幼童疼痛 ； 照護者角色緊張 ； incontinent dermatitis ； child pain ； anxiety of caregiver

護理雜誌

64卷6期（2017 / 12 / 01）

112 - 118

繁體中文

本文係探討一位幼童因家屬照護不當導致失禁性皮膚炎之照護經驗。於2015年3月27日至4月2日照護期間，筆者運用Gordon十一項功能性健康型態評估收集個案身體、心靈、與社會方面等主、客觀資料。藉由觀察、身體評估、照護過程、關懷與溝通收集個案與案母資料，確立個案健康問題有：皮膚完整性受損、急性疼痛、照護者角色緊張。針對上述三項個案健康問題，藉由個別性照護、持續性的主動關懷、傾聽與陪伴，與家屬建立良好的護病關係。依據個案喜好，運用治療性遊戲和注意力轉移技巧，以減輕個案換藥時的疼痛感受。照護期間也鼓勵家屬共同參與治療，並指導失禁性皮膚炎正確照護資訊，以降低家屬心中擔憂，並提升家屬照護能力及自信心，以利返家後個案能持續獲得完整的照護。也期望藉此照護經驗提供護理人員照顧類似個案之參考。

This paper describes the experience of caring for a child with incontinent dermatitis that was caused by improper family care. From March 27, 2015 to April 2, 2015, the authors used Gordon's 11 functional health parameters to collect subjective and objective data on the physical, mental and social conditions of the care recipient. To understand the nursing-related problems, including impaired skin integrity, acute pain, and caregiver anxiety, the data for this case and his mother were conducted by observation, physical assessment, the process of caring, and communication. For the three nursing problems, we established a good relationship with the family by providing individual care, continuously active care, listening, and companionship. In order to reduce the pain during wound dressing, we used game therapy and an attention-transfer technique that was based on the case's preferences. We encouraged family members to participate in treatment in order to ensure that the case continued to receive proper and continuous care after returning home. The authors taught the family members the correct information for treating incontinent dermatitis in order to reduce their concerns and to enhance their confidence and care abilities. We hope that this nursing experience may provide a reference for other nursing staffs when caring for similar cases in order to ensure appropriate quality of care.

1. 林采蓉、黃敏瑢、粘惠先、劉佳琪、謝佩珊、陳淑惠(2015)。降低重症病房腹瀉病人失禁性皮膚炎發生率。護理雜誌，62(6)，81-89。
   連結：
2. Blume-Peytavi, U.,Hauser, M.,Lünnemann, L.,Stamatas, G. N.,Kottner, J.,Bartels, N. G.(2014).Prevention of diaper dermatitis in infants-A literature review.Pediatric Dermatology,31(4),413-429.
3. Coughlin, C. C.,Eichenfield, L. F.,Frieden, I. J.(2014).Diaper dermatitis: Clinical characteristics and differential diagnosis.Pediatric Dermatology,31(1),19-24.
4. Hemavathy, V.,Bini Paul, V. J.,Minu, V.(2016).Astudy to evaluate the effectiveness of structured teaching programme on knowledge regarding prevention of diaper dermatitis among the mothers of infants (6 to 12 months) at Sree Balaji Medical College and Hospital Chennai.International Journal of Applied Research,2(4),557-558.
5. Jun-Tai, N.(2008).Play in hospital.Paediatrics and Child Health,18(5),233-237.
6. Kool, R.,Lawver, T.(2010).Play therapy: Considerations and applications for the practitioner.Psychiatry,7(10),19-24.
7. Koukourikos, K.,Tzeha, L.,Pantelidou, P.,Tsaloglidou, A.(2015).The importance of play during hospitalization of children.Materia Socio Medica,27(6),438-441.
8. Merkel, S. I.,Voepel-Lewis, T.,Shayevitz, J. R.,Malviya, S.(1997).The FLACC: A behavioral scale for scoring postoperative pain in young children.Pediatric Nursing,23(3),293-297.
9. Stamatas, G. N.,Tierney, N. K.(2014).Diaper dermatitis: Etiology, manifestations, prevention, and management.Pediatric Dermatology,31(1),1-7.
10. 吳家惠、高碧霞(2010)。一位吞噬球缺乏症導致蜂窩性組織炎學齡前期兒童之護理經驗。護理雜誌，57(2，附冊=2, Suppl.)，16-21。
11. 吳麗敏、陳宜坊、陳妤謙、陳寶如(2017)。治療性遊戲之臨床運用。馬偕護理雜誌，11(1)，7-17。
12. 林筱青、許晉豪、張簡志炫、楊正三(2016)。不同的皮膚照護方案對成人失禁性皮膚炎之改善成效：系統性文獻回顧。南臺灣醫學雜誌，12(2)，103-114。
13. 張翠茹、梁蕙芳(2013)。照護一位患有蕁痲疹之學齡期兒童的護理經驗。長庚護理，24(4)，463-472。
14. 陳月枝校閱(2014)。實用兒科護理。臺北市=Taipei City, Taiwan, ROC:華杏=Farseeing。
15. 陳月枝校閱(2010)。實用兒科護理學。臺北市=Taipei City, Taiwan, ROC:華杏=Farseeing。
16. 陳雪雯、陳貞如、徐瑀謙(2010)。一位頸部膿瘍住院幼兒期病童之護理經驗。嘉基護理，10(1)，36-46。
17. 黃美智校訂、蔣立琦校訂(2013)。兒科護理學。臺北市=Taipei City, Taiwan, ROC:永大=Yeong Dah Book。
18. 黃薰瑩、吳建誼、黃洽鑽(2014)。兒童安寧療護─疼痛控制。家庭醫學與基層醫療，29(4)，107-113。
19. 劉孟琪、柯識鴻、葉淑梅、陳紀雯(2010)。急性住院幼兒壓力反應及護理人員因應行為。輔仁醫學期刊，8(4)，235-242。

1. 林筱嵐(2020).一位膿胸合併呼吸衰竭患者及其家屬之加護病房護理經驗.彰化護理,27(4),73-85.
2. 王軫薇(2020)。照護一位沙門氏菌感染併發細菌性腦膜炎嬰兒之加護護理經驗。助產雜誌，61，50-59。