照護一位學齡前期兒童前額撕裂傷縫合之急診護理經驗

Emergency Nursing Experience in Caring for a Preschool Child with Forehead Laceration

陳慰親(Wei-Chin Chen)；嚴麗君(Li-Jun Yan)；黃麗霞(Li-Hsia Huang)

治療性遊戲 ； 學齡前期 ； 撕裂傷口縫合 ； therapeutic games ； preschool ； Laceration wound suture

若瑟醫護雜誌

15卷1期（2021 / 07 / 01）

118 - 128

繁體中文

此次運用治療性遊戲幫助一位5歲學齡前期病童，接受撕裂傷縫合的急診護理經驗。護理期間為2019年01月18日17:40至23:50，以全人整體性評估，包含兒童生理、心理、社會、靈性及家庭評估做為評估架構，藉由身體評估、觀察與溝通、病歷閱覽等方式收集資料，顯示病童面對陌生的醫療環境與醫護人員、對傷口縫合之侵入性治療缺乏了解、害怕治療過程中的疼痛，主要照顧者缺乏縫合傷口相關照護經驗，導致有恐懼、疼痛、照顧者角色緊張等健康問題。病童因為對右前額撕裂傷縫合感到恐懼，出現大聲哭鬧、畏縮及拒絕縫合等反應，運用治療性遊戲方式與病童溝通如角色扮演，使其了解縫合過程、降低其對未知的恐懼、激發其勇氣、以正向鼓勵其接受縫合治療；縫合過程中透過講解下一步的進度、口頭鼓勵、播放其最喜愛音樂、引導數數字去轉移注意力與增進安全感，幫助其順利完成縫合。經過本次照護經驗，建議急診醫護人員可培養治療性遊戲相關知識與技能，在未來的照護上，期望此護理經驗能提供急診護理人員在照護類似個案上有更多元化的照護。

This time, we used a therapeutic game to help a 5-year-old preschool child with emergency care experience of a laceration suture. The nursing period is from January 18, 2019, 17:40 to 23:50. The whole person's holistic assessment, including children's physical, psychological, social, spiritual, and family assessments, are used as the assessment framework. Through physical assessment, observation and communication, collecting data by reading medical records and other methods shows that children face unfamiliar medical environments and medical staff, lack of understanding of invasive treatment of wound sutures, and fear of pain during treatment. The main caregiver lacks experience in suture-related care, leading to fear, pain, nervousness of the role of caregiver, etc. The sick child was frightened of suture over right forehead laceration, and cried loudly, flinched, and refused sutures. We used therapeutic games to communicate with the sick child, such as role play, so that he could understand the suture process and reduce his exposure to the unknown. Fear, stimulate their courage, and positively encourage them to undergo suture treatment; during the suture process, explain the following step, verbally encourage, play their favorite music, guide the number to divert attention and increase the sense of security to help them to complete Suture. After this care experience, it is suggested that emergency medical staff can develop knowledge and skills related to therapeutic games. In the future care, it is expected that this nursing experience can provide emergency medical staff with more diversified care in similar cases.

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