一位護理人員產婦面臨胎兒異常選擇終止妊娠之照護經驗

本文是在探討一位23＋2週護理人員產婦因胎兒異常選擇終止妊娠，經歷引產、哀傷及調適過程之護理經驗。照護期間自2016年12月18日至12月20日，筆者藉由直接照顧、觀察、會談等方式，運用護理專業溝通技巧收集個案生理、心理、社會及靈性等層面資料，確立個案有急性疼痛／與子宮收縮有關、哀傷／與失去胎兒有關、罪惡感／與無法達成母性角色有關等健康問題。照護重點除了帶領呼吸放鬆技巧，以減輕疼痛、促進舒適，並藉由建立良好的護病關係，引導抒發內心的感受，同理、接納個案的哀傷情緒，適時的陪伴與傾聽，協助接受終止妊娠及失去孩子的事實，以尊重生命的態度，協助夫妻雙方進行胎兒告別儀式，抒發悲傷情緒減輕心中罪惡感。產科護理人員多是迎接新生兒的喜悅情境，鮮少面臨死亡，面對同為護理人員的同仁哀傷難過，不管心情多麼複雜，都不會輕易表露出內心的感受，期望藉此傷慟關懷照護經驗能提醒臨床醫護人員注重此類產婦之心理問題，提升心理層面照護的能力，建議能建置個案管理師，建立出院追蹤系統，進而提供更人性化的連續性關懷照護。

關鍵字

護理人員產婦；終止妊娠；哀傷；罪惡感

並列摘要

This article is discussing a caring experience in a fellow nurse, who was 23 + 2 weeks into her pregnancy, but chose termination due to fetal abnormality. She faced labor induction, experiences grief during the process of self-adjustment. By direct caring, observation, and discussion between the periods of December 18th to 20th of 2016, the author applied professional nursing communication skills to collect the patient's mental, physical and psychological information. The patient was diagnosed with health matters such as acute pain concerning uterine contraction, grief from fetal demise related to the loss of baby, and guilt occurred from incapable of fulfilling a mother's role. In order to relieve the pain and enhance some comfort, breathing relaxation techniques were applied. Also, sharing empathy, inviting the emotional expression was conducted for the sake of building a good nurse-patient relationship. Other ways of caring includes listening, acknowledging the patient's despair and offering essential companion. As aiming to assuage t he guilt emotion, the author assisted the patient in accepting the fact of termination and fetal loss as well as holding a farewell ritual with the attitude of life respect to assist both husband and wife to express their sorrow and relive guilty feeling. Obstetric nurses are predominantly surrounded by joy of new birth with rare disaster. Despite the author shared the same sorrow and complex emotion of the obstetric nursing colleague, it is ethically justifiable not to display the genuine feeling. Hopefully this depressed caring experience brings more attention to the mental health of similar patients and improves the nurses' ability to nursing care. Thus, we recommend the establishment of case managers and set up follow-up tracking system to further provide continuous humanity caring service.

並列關鍵字

Pregnant nurse ； Termination of pregnancy ； grief ； guilty

參考文獻

Gravensteen, I. K., Helgadottir, L. B., Jacobsen, E. M., Sandset, P. M., & Ekeberg, I.(2012). Long-term impact of intrauterine fetal death on quality of life and depression: acasecontrol study. BMC Pregnancy and Childbirth, 12(43), 2-9. doi:10.1186/1471-2393-12- 43.

吳昭華 ( 2013 ) . 產科醫療領域中催產素之應用與建議 . 助產雜誌 55 · 9-20 •