過去有剖腹產麻醉經驗不佳之護理經驗

Nursing Experience of Caring a Expectant Mother with Previous Painful Caesarean Section Anesthesia

甘鴻蓉(Hung-Jung Kan) ； 王惠卿(Huei-Ching Wang)

《北市醫學雜誌》 6卷3期 (2009/06) Pp. 215-226

https://doi.org/10.6200/TCMJ.2009.6.3.07

摘要

目的：本文旨在描述一位臨床麻醉護理人員照顧前胎剖腹生產產婦對麻醉經驗不佳的照護經驗，護理期間自97年7月27日至7月29日。方法：藉由雙向溝通、陪伴、傾聽、觀察、身體評估等方式，收集身體、心理、社會及靈性等方面的資料，運用Gordon 11項健康功能型態為架構及手術全期照護計劃協助個案達成母嬰親善，確立護理問題有：一、焦慮／與麻醉過程不了解有關；二、健康尋求行為／母嬰接觸有關；三、潛在危險性傷害／手術其間擺位之傷害、組織完整性受損有關；四、急性疼痛/組織創傷（手術）有關。結果：有效降低個案焦慮及不信任感，緩解傷口疼痛，滿足個案的母嬰親善需求，恢復個案對麻醉人員的信任。結論：藉由麻醉前評估讓個案與家屬可以傳達個案的身體狀況及過去經驗，與麻醉醫療人員共同討論如何實施安全及有效麻醉，解除對麻醉的疑惑及害怕，恢復個案對麻醉人員的信任；運用手術前、中、後的照護，能有效降低個案的焦慮及不信任感，並能達到滿足個案與嬰兒的母嬰親善需求。

關鍵字

產科麻醉 ； 母嬰親善醫院 ； 術後自控式止痛

並列摘要

Background and Purpose: This article describes an anesthetic nurse's experience of taking care of a patient who felt unpleasant about previous anesthesia for caesarean section. The author provided the nursing care from July 27 to July 29, 2008. Method: Data about physical, psychological, social, and spiritual of the case were collected by bidirectional communication, companion, listening, observation, and physical assessment. Applied Gordon 11-item health assessment and peioperative nursing to help the case fulfill mother-baby-friendly. We identified four nursing problems, including (1) Anxiety/poor perception on anesthesia (2) Need for healthseeking behaviors/about mother-baby contact (3) Potential risk of injury/related to operative position and damage of tissue completeness (4) Acute pain/about tissue (operation) wound. Results: Reduced the patient's anxiety and doubt effectively. She regained confidence in anesthetic personnel. The need of mother- baby-friendly was also satisfied. Conclusion: The patient and her family members can express her health condition and previous anesthetic experience during preoperative evaluation. Besides, they can discuss with the anesthetist about how to perform a safe and valid anesthesia, which can reduce the patient's doubt and worry about anesthesia. This method can relieve the patient's anxiety effectively and make her confident in anesthetic personnel. The need of mother- baby-friendly is also satisfied.

並列關鍵字

obstetric anesthesia ； Baby Friendly Hospital ； patient-controlled analgesia