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

Nursing Experience in a Primipara Woman Facing Mental Distress of Possible Peripartum Neonatal Asphyxia

賴郁芳(Yuh-Fung Lai) ； 黃珮春(Pei-Chun Huang)

《臺大護理雜誌》 16卷1期 (2020/01) Pp. 114-126

https://doi.org/10.6740/NTUHJN.202001_16(1).0011

摘要

懷孕與生產於婦女生命週期具有重要的歷程意義，隨著妊娠週數逐漸增加，進入面臨分娩時期，核心的信念和願望為生下健康新生兒，然而在待產過程中，若發生胎兒心跳減速引起窘迫現象時，母親因擔心新生兒面臨生命威脅問題，常出現食慾下降、失眠、自責及罪惡感等情形，且身心的困擾會持續直至下次懷孕。本文描述一位初產婦於分娩過程，面臨胎兒因周產期窒息而緊急剖腹產之護理過程，護理期間自2017年5月2日至5月7日，運用Gordon 11項健康功能性型態評估，藉由觀察、陪伴、傾聽及會談等方式收集資料並分析，確立個案健康問題包括急性疼痛、哀傷及罪惡感。護理期間提供整體性及個別性的照護，藉由按摩減輕待產時陣痛，剖腹產後教導自控式止痛的使用及漸進式下床以緩解疼痛；運用傾聽及陪伴，引導個案與案夫雙向溝通並說出心中的感受，並安排婦產科及兒科醫師向個案及其家屬說明以避免對新生兒死因產生誤解。建議在產婦面臨不同階段產生的情緒問題，也應列入護理交班，才能持續性提供產婦及家屬情緒支持的照護，且可成立產婦關懷小組進行電訪追蹤，增加相關安寧哀傷輔導課程，更能發揮以家庭為中心的整體照護。

關鍵字

周產期窒息 ； 哀傷 ； 安寧療護

並列摘要

Pregnancy and childbirth have a substantial psychological impact on women's lives. When approaching the timing of delivery during pregnancy, unexpected outcomes such as fetal heartbeat deceleration, shoulder dystocia, and asphyxia of the undelivered baby can cause various forms of psychological distress, including loss of appetite, insomnia, self-blame, and guilt, which can continue until the next pregnancy. This study describes the nursing process of a primipara undergoing emergency cesarean section due to perinatal asphyxia. During the nursing period from May 2^(nd) to May 7^(th) , 2017, the author used Gordon's eleven health function assessments to evaluate the nursing process. By observing, accompanying, listening, and talking, the author collected and analyzed data to establish the main problems of acute pain, grief, and guilt. Care integrity and individuality were given throughout the full nursing process. Multiple skills were taught to the patient in order to improve the whole peripartum process; these included massage to relieve natural labor pain, PCA usage, and early ambulation after cesarean section to relieve pain. Listening and companionship were used to guide the case and the family to communicate and express their feelings and comfort each other in a bidirectional manner. Obstetricians and neonatologists were arranged to give the family members explanations in order to avoid misunderstandings regarding the cause of neonatal death. It is suggested that the emotional problems arising in the different stages of a case should also be included in the shift in order to provide progressive care for the case and emotional support for the case-holder; the unit can also set up a case care group to conduct telephone interviews and follow-up calls. Increasing relevant grief education is also recommended.

並列關鍵字

peripartum neonatal asphyxia ； grief ； hospice care