一位周產期窒息新生兒接受安寧療護之護理經驗

本文主要探討一位因周產期窒息新生兒出生即經高級急救救命術急救後，仍出現不可逆的腦損傷，因預後不佳，故接受安寧療護介入之護理經驗。護理期間為2020年3月23日至2020年4月2日止，筆者運用臨床觀察、系統性身體評估、會談及家庭評估收集資料，確立病嬰有：氣體交換障礙、潛在危險性無效性腦組織灌流、新生兒父母的哀傷等健康問題。護理病嬰期間提供個別性護理，降低碰觸病嬰時的力道及協助舒適擺位，保持呼吸道通暢及減少其身體上的痛苦；對於父母親的心理關懷，除了鼓勵及協助引導父母親哀傷情緒的宣洩，並擔任醫療團隊與家屬間溝通的橋樑，統合跨領域團隊資源，提供新生兒安寧緩和療護的照護理念，提供以家庭為中心的護理，陪伴案父母度過孩子的死亡歷程。希冀藉此護理經驗分享提供臨床護理人員面對相似病嬰之參考，以維持家庭功能的正常運作，達到全人、全家之護理目標，展現護理之美。

關鍵字

新生兒；周產期窒息；安寧療護

並列摘要

This article described the nursing care of a patient had received cardiopulmonary resuscitation immediately after birth; nevertheless, irreversible brain damage still occurred. The patient received hospice care thereafter. The study period was from March 23, 2020 to April 2, 2020. Data was collected through observations, physical assessments, conversations, and family assessment, we were able to evaluate and define the patient’s physiological needs, which includes impaired gas exchange, risk for ineffective cerebral tissue perfusion, grief of the parents. We found providing individual care during the nursing of the case, reducing the force when touching, assisting in comfortable positioning, will keep the airway unobstructed and reduce physical pain. For the psychological care of parents, in addition to encourage and assist the parents to understand the sadness vent, nurses were the only communication bridge between the medical team and family. Integrating cross-domain team resources provided information regarding neonatal hospice care and applied family center model to assist the parents pass a death process. This nursing experience may serve as a reference for clinical nurses in caring for terminally ill patients. In order to achieve the goal of care for the whole person and the whole family, this article showed the beauty of nursing.

並列關鍵字

newborn ； perinatal asphyxia ； hospice care

參考文獻

賴郁芳、黃珮春。一位初產婦於分娩過程面臨新生兒周產期窒息死亡之護理經驗。台大護理 2020；16(1)：114-126。[Lai, Y. F., & Huang, P. C. Nursing experience in a primipara woman facing mental distress of possible peripartum neonatal asphyxia. Nursing National Taiwan University Hospital Journal of Nursing 2020; 16(1): 114-126.] https://doi.org/10.6740/NTUHJN.202001_16(1).0011

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