運用Swanson關懷理論照護周產期哀傷家庭之護理經驗

Nursing Experience of Family Who Experience Perinatal Grief Using Swanson's Theory

林湘芸(Hsiang-Yun Lin) ； 馬悅華(Yueh-Hua Ma) ； 蔡惠華(Hui-Hua Tasi) ； 楊式辰(Shih-Chen Yang)

《北市醫學雜誌》 16卷3期 (2019/09) Pp. 262-272

https://doi.org/10.6200/TCMJ.201909_16(3).0009

摘要

本篇個案報告係運用Swanson關懷理論於照護一位高齡經產婦在懷孕33＋6週，面對引產疼痛、失去胎兒哀傷及協助家庭運作能力增進的護理經驗。護理期間自2017年3月3日至2017年3月5日，作者運用Gordon十一項健康功能性為評估架構，並藉直接照顧、觀察、溝通會談等方式收集資料，確立主要健康問題包括疼痛／與子宮收縮及缺乏疼痛控制技巧有關；哀傷／無法接受胎兒失去有關及家庭因應能力增進準備度／與失去胎兒有關。經由提供多媒體及示範教導方式指導生產球使用及拉梅茲呼吸法；運用Swanson關懷照護模式及啟動跨專業團隊合作，適時引導產婦及案夫能表達出對胎死腹中內心感受，陪伴支持個案及家庭對逝去胎兒完成四道人生，提供出院專線後續關懷追蹤家庭運作能力等；結果使個案引產疼痛指數可下降；家庭為逝去胎兒捻香祈福希望早日投好胎；主動提出解剖查詢胎死腹中原因，提供經驗避免他人一樣遭遇等，終能夠正向接受並因應短暫生命的重要性與意義。本文建議應用關懷照護理論，套印設計周產期哀傷溝通擬真劇場演練及舉辦哀傷輔導工作坊等訓練，以提供並提升臨床人員相關照護之模擬應變技巧及能力。

關鍵字

生產球 ； Swanson關懷照護 ； 周產期哀傷

並列摘要

This case study describes a nursing care experience that helped an older age multipara to encounter labor pain and perinatal grief at 33+6 gestational weeks and enhance her family operations. During the nursing period between March 3 to 5 in 2017, the Gordon 11-item Health Functional Patterns model was used for observation, interview, communication, and consultation. The following health problems were identified: 1. pain, which related to uterine contractions and lack of pain control skills; 2. grieving, which related to inability to accept the fetal death; 3. unreadiness for enhancing family operations, which related to fetus loss. Through multimedia and demonstrations, we introduced the use of birth ball and Lamaze breathing method to the mother. Swason's caring theory and initiation of inter-professional practice can guide the mother and the father timely to express their feelings on the intrauterine fetal death. We accompanied the clients and family to complete the four themes of life and provided dedicated line for follow-up care and track of family ability to operate. The results were: (1) a reduction of maternal induction pain; (2) the family blessed the fetus for a smooth reincarnation and soon re-birth; (3) actively proposed an anatomy to investigate the reasons of fetus death so that others may avoid the incident; (4) able to accept and respond to the importance and significance of a short-lived life. We recommend the application of Swason's caring theory, practice of perinatal grief communication in simulation theatre, and grief counseling workshops to enhance the resilience and ability of caring skills of the staff.

並列關鍵字

birth ball ； Swason's caring theory ； perinatal grief