- 期刊
照顧一位早期破水產婦安胎失敗之護理經驗
Nursing Experience of a Mother with Premature Rupture of Membrane and Tocolysis Failure
摘要
本篇文章主要是探討照顧一位早期破水孕婦住院安胎，因疑似羊膜炎感染行剖腹產終止妊娠並經歷新生兒死亡之護理經驗。護理期間自2017年6月6日至2017年7月24日，筆者藉由身體評估、會談、傾聽、觀察等技巧收集資料，運用Gordon十一項健康功能性評估，確立個案有舒適障礙、焦慮、哀傷等健康問題；在舒適障礙方面：提供安胎藥物使用、副作用之認識及教導因應措施，降低對副作用不適的感受及提供輔具維持舒適擺位，減緩肢體痠痛；在焦慮方面：運用傾聽陪伴、教導轉移注意力方式及介紹類似個案經驗分享，婦兒科醫療團隊合作並充分說明安胎情況，降低其焦慮情形；哀傷方面：給予關懷、陪伴與支持，安排獨立空間，在護理人員的引導下，參與臨終死亡過程與孩子道別，使其能適時表達失去新生兒的傷痛情緒。建議護理人員參加哀傷輔導技巧工作坊及成立家庭團體哀傷治療之門診或支持團體，持續追蹤有相同遭遇、經歷悲痛情緒的家庭，共同扶持走出哀傷歷程。期望藉此護理經驗能提供臨床護理人員照護此類個案之參考。
並列摘要
This article investigated the nursing experience of caring for a patient with Premature Rupture of Membrane and subsequently hospitalized for tocolysis. As a result of suspected amnionitis, Caesarean Section was administered to terminate the pregnancy and thus neonatal death occurred inevitably. The author provided direct care during the period of June 6th to July 24th, 2017. Data was collected through techniques such as physical assessment, interviews, listening and observation. Based on Gordon's 11 functional health patterns, the patient's health problems were identified as follows: disruption of comfort , anxiety, and grief. In terms of disruption of comfort, the use of tocolytic agents and the understanding of the medication's side effects were provided, along with coping measures in such as repositioning in reducing the feeling of discomfort. Regarding the issue of anxiety, listening, providing companionship, teaching distraction techniques, and thorough explanation of the current situation from multidisciplinary team consisted of maternity and children expertshave reduced the patient's level of anxiety. With respect to the grief problem, being caring, offering companionship, provision of support, and arranging a private area, under the guidance of the nursing staff, allowing the patient to agnite and experience the farewell ceremony with the child and to express the loss of a newborn may help with her coping. It is recommended to establish an outpatient or support scheme as a form of grief therapy for family groups, and to continue follow-up in helping other families sharing similar experiences and support each other through their grieving process. We hope that the nursing experience can provide as a reference and some insight for clinical nursing staff while caring for similar cases in future.