一位子宮內胎兒死亡之產婦面臨周產期失落歷程之照護經驗

The Nursing Experience of Caring for a Female Patient Undergoing Perinatal Loss after Intrauterine Fetal Death

洪意華(Yi-Hua Hung) ； 吳淑蓉(Shu-Jung Wu)

《高雄護理雜誌》 26卷1期 (2009/05) Pp. 76-90

https://doi.org/10.6692/KJN-2009-26-1-7

摘要

本文旨在敘述一位產婦在確定子宮內胎兒死亡後，護理人員協助其渡過周產期失落歷程之護理經驗。護理期間為民國95年4月11日至95年4月14日，並於出院後每個月一次之電話追蹤方式，連續三個月以持續瞭解個案調適情形。經由Gordon十一項健康功能性型態進行整體性評估，以觀察、會談及諮詢等方式收集資料。發現個案主要的健康問題有：(1)疼痛；(2)預期性哀傷；(3)情境性低自尊；(4)心靈安適增進的準備度。針對其問題給予的護理重點是：(1)減輕引產造成的不適；(2)協助表達哀傷及罪惡感並接受失去孩子的事實；(3)協助個案肯定自我並恢復母親角色；(4)增進與胎兒在心靈上的連結。整個護理過程除了給予生理的照護需求外，並從心理、靈性及社會層面來深入探討，瞭解個案真正的感受、想法及態度並提供適時適境之整體性照護，協助個案渡過哀傷過程，進而恢復正常生活。

關鍵字

周產期失落 ； 哀傷 ； 子宮內胎兒死亡

並列摘要

The purpose of this article is to describe the nursing experience of caring for a female patient undergoing perinatal loss after intrauterine fetal death. The patient was hospitalized from April 11 until April 14, 2006, and was contacted once every month by telephone after the patient had left the hospital. This method was continued for three months in order to understand the patient's adaptive condition. Utilizing the Gordon for health problem identification, a well-rounded evaluation was done. Information was collected through careful observation, interview, consultation and physical assessment. It was noted that this patient's health problems were: (1) Pain; (2) Anticipatory grieving; (3) Situational low self-esteem; and (4) Readiness for enhanced spiritual well-being. To treat these problems, the main nursing strategies were: (1) To reduce discomfort from labor induction; (2) To assist the patient in expressing her grief and guilt and accepting the fact that she had lost her baby; (3) To assist the patient in self-approval and returning to her role as a mother; and (4) To enhance her spiritual connection with the baby. During the patient's hospitalization, we did more than just attend to her physiological needs. Through an in-depth psychological, spiritual and social evaluation, we tried to understand the patient's genuine thoughts, feelings, and attitude in order to provide her with well-rounded care. Our care assisted the patient in passing through her grief and returning to a normal lifestyle.

並列關鍵字

Perinatal loss ； Grief ； Intrauterine fetal death