運用死產之關懷照護於一位高齡初孕婦剖腹產之護理經驗

Providing Nursing Care to an Elderly Primipara Experiencing Stillborn Birth After Caesarean Section

李淑惠(Shu-Hui Lee) ； 陳馥萱(Fu-Hsuan Chen)

《志為護理-慈濟護理雜誌》 17卷1期 (2018/02) Pp. 140-148

摘要

本文是一位懷孕27^(+2)週卻意外發現胎死腹中，因植入性胎盤而剖腹生產的40歲初產婦之護理經驗，筆者於2014年11月3日至11月8日期間，藉觀察與會談收集資料，確認產婦有潛在性出血損傷、哀傷、焦慮等護理問題。筆者運用「臺灣經歷死產婦女所認同的關懷照護經驗」，以「真心瞭解、與我同在」主動傾聽、同理產婦的感受；以「提供自己」陪伴及引導其夫妻互相支持，建議以母親的角色祝福孩子，轉換其自責感；以「提供選擇」讓產婦執行胎兒娩出後的母職角色；以「預先告知」預防產後大出血等併發症，協助其「掌控情況」；運用「經驗分享」增加其對再孕的信心。筆者建議可透過更具本土文化的關懷照護，幫助我國死產婦女走出哀傷。

關鍵字

關懷照護 ； 哀傷 ； 植入性胎盤 ； 周產期死亡 ； 死產

並列摘要

This article described an nursing experience of an elderly primipara with intrauterine fetal death at pregnancy 27^(+2) weeks and delivered via caesarean section due to placenta previa and placenta accreta. Data were collected through observation and conversation from November 3^(rd) to 8^(th), 2014, and the following nursing issues were identified: potential bleeding, anxiety, and grief. By adopting nursing experiences that were recognized by Taiwanese women with stillbirth experience as guidance, we listened and empathized with the patient, provided companionship and guidance to the patient and her spouse in supporting each other, recommended the patient to bless her child with the role of a mother to transform self-blame, provided choices to the patient to allow her to play the maternal role after delivery, forewarned the patient to prevent complications like postpartum hemorrhage and to assume control of the situation, and enhanced the patient’s confidence in future pregnancy through experience sharing. We recommend the use of nursing care plan that complies with the local culture in assisting Taiwanese women experiencing stillbirth with their grief.

並列關鍵字

grief ； nursing care ； perinatal death ； placenta accreta ； stillbirth