運用治療性遊戲於一位學齡期兒童撕裂傷縫合之急診護理經驗

An Emergency Nursing Experience of Applying Therapeutic Play to a School-Age Child Undergoing Suturing of Laceration

邱怡菁(I-Ching Chiu)；郭嘉琪(Chia-Chi Kuo)

治療性遊戲 ； 撕裂傷口縫合 ； 焦慮 ； anxiety ； suture of laceration ； therapeutic play

志為護理-慈濟護理雜誌

16卷5期（2017 / 10 / 01）

94 - 103

繁體中文

本文旨在探討運用治療性遊戲幫助一位7歲學齡期病童，接受撕裂傷縫合的急診護理經驗。護理期間為2014年11月07日12:30至13:15，以兒童生理、發展、就醫壓力與家庭評估為評估架構，透過身體評估、觀察、溝通、病歷閱覽等方式收集資料，確立病童有組織完整性受損、焦慮之健康問題。病童因為對額頭撕裂傷縫合感到害怕、焦慮，出現畏縮、哭鬧、拒絕縫合等反應，筆者利用治療性遊戲方式使其了解縫合過程、減少對未知的恐懼、激發勇氣、鼓勵其接受縫合治療；縫合過程中透過進度講解、緊握雙手、口頭鼓勵、引導數數字轉移注意力與增進安全感，幫助其順利完成縫合。基於本照護經驗，建議急診醫護人員應該培養治療性遊戲的能力，以提供兒童最佳的急診就醫品質。

This paper describes an emergency nursing experience of applying therapeutic play to assist a 7-year-old school age pediatric patient during the suturing of laceration. The nursing period lasted from 12:30 to 13:15 on November 7, 2014. With pediatric physiology and development, hospitalization stress, and family evaluation as an assessment framework, data were collected via physical evaluation, observation, conversation, and chart review. The patient was identified with impaired tissue integrity and anxiety. During the suturing of forehead laceration, the pediatric patient exhibited fear, anxiety, and displayed reactions such as flinching, crying, screaming, and refusal to undergo suturing. We applied therapeutic play to help the patient to overcome the fear of unknown by understand the suturing process, to inspire courage, and to encourage the patient to receive suturing. During the suturing process, we applied interventions including progress explanation, hand holding, verbal encouragement, shifting attention by number-counting, and instilling a sense of security to aid the completion of the suturing. Based on this nursing experience, we would like to recommend emergency nurses to develop capabilities to engage in therapeutic play to provide children with highest quality of emergency care.

1. 王秀玲,吳美玲(2015)。照顧一位學齡期氣喘兒童對藥物不遵從之護理經驗。志為護理慈濟護理雜誌，14(5)，93-103。
   連結：
2. 許家樺,馮瑞鶯(2015)。運用治療性遊戲於一位罹患噬血症候群學齡前期兒童之加護照顧經驗。護理雜誌，62(2)，96-102。
   連結：
3. Haiat, H.,Bar-Mor, G.,Shochat, M.(2003).The world of the child: A world of play even in the hospital.The Journal of Pediatric Nursing,18(3),209-214.
4. Hoyt, K. S.,Flarity, K.,Shea, S. S.(2011).Wound care and laceration repair for nurse practitioners in emergency care: Part II.Advanced Emergency Nursing Journal,33(1),84-99.
5. Li, W. H.,Chan, S. S.,Wong, E. M.,Kwok, M. C.,Lee, I. T.(2014).Effect of therapeutic play on pre- and post-operative anxiety and emotional responses in Hong Kong Chinese children: A randomised controlled trial.Hong Kong Medical Journal,20(7),36-39.
6. Patel, P. R.,Miller, M. A.(2007).Post care recommendations for emergency department wounds.Emergency Medicine Clinics of North America,25(1),147-158.
7. Vaezzadeh, N.,Douki, Z. E.,Hadipour, A.,Osia, S.,Shahmohammadi, S.,Sadeghi, R.(2011).The effect of performing preoperative preparation program on school age children's anxiety.Iranian Journal of Pediatrics,21(4),461-466.
8. 王月伶,駱麗華(2006)。治療性遊戲。護理雜誌，53(3)，79-83。
9. 王姵雅,林佳蓉,謝伶瑜,林姿佳(2014)。運用術前準備照護計畫降低兒童與父母之焦慮。臺灣醫學，18(3)，361-366。
10. 林杏麟,李維哲(2014)。外傷傷口的處置流程。臺灣醫界，57(2)，24-26。
11. 胡勝川,張茵琇(2011).PALS和APLS精華.新北市:金名.
12. 陳月枝（校閱）(2010).實用兒科護理.臺北市:華杏.
13. 衛生福利部（2016，8月5日）．104年主要死因統計結果分析 ．取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=6201
14. 鄧湘君,吳家麗,李惠珍,趙慧玲(2013)。急診外傷病人護理指導之改善專案。志為護理，12(2)，80-90。
15. 謝宜娟,劉惠姿,卓燕華(2012)。降低學齡前期兒童接受靜脈注射恐懼程度之專案。護理雜誌，59(3)，79-86。