一位因胎兒染色體異常接受終止妊娠婦女面臨哀傷之護理經驗

本文旨在描述一位妊娠19^(+6)週之經產婦、因胎兒第十八對染色體異常而需面臨終止妊娠，經歷失落和哀傷之護理經驗。照護期間為2020年3月22日至3月26日，運用Gordon十一項功能性健康型態為評估工具，經由實際參與照護、觀察、會談、傾聽、身體評估等方式收集資料，確立個案健康問題有：「急性疼痛／與剖腹產傷口有關」、「哀傷／與失去胎兒有關」、「情境性低自尊／與胎兒異常無法達成母性任務有關」。照護期間筆者運用主動關懷、傾聽、陪伴及同理心等技巧建立良好護病關係及信任感，依個案需求提供照護，使用放鬆技巧及非藥物性處置減緩傷口疼痛，滿足個案之生理需求；提供人性化的關懷照護，於術前給予詳盡解釋及引導表達內心的感受及情緒宣洩，鼓勵家人陪伴、交談、分享內心哀傷情感，運用宗教信仰力量，尋求心靈上的慰藉。協助個案與其家屬自傷慟中逐步走出陰霾，渡過終止妊娠之哀傷過程，接受失去胎兒的事實、重新規劃未來生活，有勇氣面對下一次懷孕。期望藉此照護經驗分享，讓婦女身、心、靈的整體性照護更加完善。

關鍵字

胎兒染色體異常；終止妊娠；哀傷

並列摘要

This article aims to illustrate the nursing experience of a grieving woman at nineteen plus six weeks of pregnancy with abnormal eighteenth pair of chromosomes in the fetus, experiencing loss and grief after termination of pregnancy. The nursing period covers from March 22 to 26, 2020. By using "Gordon Eleven Functional Health Patterns", the author collected information from observation, interviews, listening and physical assessments to establish health issues including: "Acute pain: related to post-caesarean section wounds", "Grief: related to fetal death due to termination of pregnancy", "Situational low self-esteem: related to the fetus's abnormal hence inability to fulfill maternal missions". During nursing period, the author applies active care, listening, companionship and empathy to establish a good nurse-patient relationship and mutual trust. Provide humanized care, relaxation techniques and non-drug treatment to relieve wound pain and express inner feelings before surgery. Encourage family companionship, communication, sharing grief, access religion belief to seek spiritual comfort. Assisting the case and her family to gradually get out of the state of sorrow, passing through the grieving process of termination of pregnancy, accept the fact of losing the fetus, re-design the future life, and have the courage to face the next pregnancy. Hopefully, through sharing this nursing experience, the holistic care of women's physical, psychological, and spiritual could be more precise.

並列關鍵字

fetal chromosomal abnormalities ； termination of pregnancy ； grief

參考文獻

林湘芸、馬悅華、蔡惠華、楊式辰（2019）．運用 Swanson 關懷理論照護周產期哀傷家庭之護理經驗．北市醫學雜誌，16(3)，262-272 。 https://doi.org/10.6200/TCMJ.201909_16(3).0009

Sun, J. C., Rei, W., Chang, M. Y., & Sheu, S. J. (2018). The experiences of fathers whose spouses are hospitalized for pregnancy termination due to fetal chromosome abnormality in Taiwan. The Journal of Nursing Research, 26(4), 297-305. https://doi.org/10.1097/jnr.0000000000000246

李孟蓉、洪小媜、彭美瑛（2017）．一位因胎兒異常接受終止妊娠婦女面臨哀傷之護理經驗．助產雜誌， 59 ， 46-57 。 https://doi.org/10.6518/TJOM.201712(59).0005

林玉蘭、謝郁芬（2018）．一位因胎兒染色體異常行終止妊娠孕婦之生產照護經驗．助產雜誌，60，22-31 。 https://doi.org/10.6518/TJOM.201812(60).0003

洪彩純、林德華（2018）．一位歷經二次胎死腹中終止妊娠產婦之護理經驗．助產雜誌，60，71-81。https://doi.org/10.6518/TJOM.20 1812 (60).0008

主題瀏覽