運用多元輔助療法照顧一位學齡期兒童急性骨髓炎之護理經驗

Nursing Experience of Using Multiple Adjunct Therapies for Caring a School-age Child with Acute Osteomyelitis

10.29494/LN.202206_23(2).0005

江俞瑩(Yu-Ying Jiang)；郭惠貞(Hui-Chen Kuo)

輔助療法 ； 學齡期 ； 急性骨髓炎 ； adjunct therapy ； school age ； acute osteomyelitis

領導護理

23卷2期（2022 / 06 / 01）

58 - 73

繁體中文

本文探討一位學齡期兒童因上呼吸道感染併發急性骨髓炎接受清創手術治療之護理經驗，筆者於2019年11月5至11月21日照護期間，以Gordon十一項功能性健康型態評估工具，藉由觀察、會談、病歷閱讀及臨床照護等方式收集資料，確立病童健康問題，包括：現存性感染、疼痛、焦慮等。照護期間觀察傷口外觀有無紅腫、滲液，換藥時嚴格執行無菌技術，以減少感染，維持生命徵象穩定。藉由疼痛評估、換藥前給止痛藥，換藥時動作輕柔，以及聽音樂、看影片來分散病童注意力，減輕傷口疼痛。病童因骨髓炎造成右腳疼痛無法移動，害怕腳再也無法走路，接受手術清創後，擔心骨骼生長板破壞，導致長短腳殘缺，心神不定、煩惱、害怕而產生焦慮。護理人員運用多元輔助療法，共同參與，藉由繪畫表達住院中內心的感受，並使用各種藝術創作，提升情緒適應力；而與醫院小丑的互動，在療癒過程中予以病童心靈上的撫慰、釋放壓力，以促進良好的照顧成效。建議醫護團隊在照護病童過程中，運用多元輔助療法前，應先召開全人會議，與藝術治療師及醫院小丑共同討論，設計個別性的輔助療法，紓解醫護與病童執行侵入性治療時的焦慮及壓力，讓病童有勇氣面對病魔的力量。

This article discusses the nursing experience from taking care of a school-age child receiving debridement surgery for upper respiratory tract infection complicated by acute osteomyelitis. During the period of care from November 5 to 21, 2019, the author used Gordon's Eleven Functional Health Assessment Tool, by means of observation, interviews, medical records reading, and clinical care to collect data. The diagnosis confirmed the sick child's health issues include existing infections, pain, and anxiety. During the nursing period, whether the wound appears redness and exudation need to be observed, and strictly implement the aseptic technique during medication change in order to reduce infection and maintain stable vital signs. For pain management, giving painkillers before medical dressing and gentle movement during dressing change, also listening to music and watching videos to distract sick child for relieving wound pain. However, due to discomfort in the case' right foot with osteomyelitis, the sick child was scared about himself no longer able to walk again, with undergoing surgical debridement, he also got worried about the destruction of the bone growth plate that may results in Leg Length Discrepancy; these made him anxious as he suffers from uncertainty, worry, and fear. The nursing staff used multiple adjunct therapies to participate together, to help the sick child to express his inner emotion through paintings as well as various artistic creations to improve emotional adaptation. Furthermore, the interaction with hospital clowns provides psychological consolation to sick children during the healing process, release stress in order to promote good care outcomes. It is suggested that the medical team should hold a holistic meeting before using multiple complementary therapies in the process of caring for sick children; discussion with art therapists and hospital clowns and plan individual complementary therapies to relieve the pressure of medical staff and sick child during invasive treatments procedure, so the sick child has the courage to face the disease.

1. 黃傅永,楊雅鈞(2018)。運用藝術治療在學齡期白血病病童住院適應的影響歷程。健康科技期刊，4(2)，35-53。
   連結：
2. Addison, N. O.,Pfau, S.,Koka, E.,Aboagye, S. Y.,Kpeli, G.,Pluschke, G.,Junghanss, T.(2017).Assessing and managing wounds of Buruli ulcer patients at the primary and secondary health care levels in Ghana.Public Library of ScienceNeglected Tropical Diseases,11(2),e0005331.
3. Chiappini, E.,Mastrangelo, G.,Lazzeri, S.(2016).A case of acute osteomyelitis: An update on diagnosis and treatment.International Journal of Environmental Rresearch and Public Health,13(6),539.
4. Dionigi, A.,Gremigni, P.(2017).A combined intervention of art therapy and clown visits to reduce preoperative anxiety in children.Journal of Clinical Nursing,26(5-6),632-640.
5. Friedrichsdorf, S. J.(2016).Prevention and treatment of pain in hospitalized infants, children, and teenagers: From myths and morphine to multimodal analgesia.International Association for the Study of Pain,309-319.
6. Iguina, M. M.,Kashan, S.(2019).Art Therapy.StatPearls.
7. Kristensen, H. N.,Lundbye-Christensen, S.,Haslund-Thomsen, H.,Graven Nielsen, T.,Elgaard Sorensen, E.(2018).Acute procedural pain in children.The Clinical Journal of Pain,34(11),1032-1038.
8. Li, W. H. C.,Chung, J. O. K.,Ho, K. Y.,Kwok, B. M. C.(2016).Play interventions to reduce anxiety and negative emotions in hospitalized children.Biomedicine Central Pediatrics,16(1),36.
9. Thakolkaran, N.,Shetty, A. K.(2019).Acute hematogenous osteomyelitis in children.The Ochsner Journal,19(2),116-122.
10. van Venrooij, L. T.,Barnhoorn, P. C.(2017).Hospital clowning: Apaediatrician's view.EuropeanJournal of Pediatrics,176(2),191-197.
11. 林雅娟,李佳倫(2016)。一位紅斑性狼瘡併骨髓炎病童之照護經驗。安泰醫護雜誌，22(1)，47-58。
12. 張綠怡,蔡綠蓉(2017)。院兒童之反應及其護理。實用兒科護理
13. 楊淑貞(2014)。敘事取向表達性藝術治療之理論探究。台灣藝術治療學會，3(2)，31-45。