一位初為人母的産後憂鬱症患者之護理經驗

A Nursing Experience with a Primipara with Postpartum Depression

黃秋敏(Chiu-Min Huang) ； 洪翠妹(Tsui-Mei Hung) ； 楊子慧(Tsu-Hui Yang)

《精神衛生護理雜誌》 3卷1期 (2008/10) Pp. 59-65

https://doi.org/10.6847/TJPMHN.200810_3(1).0009

摘要

本文是一位初為人母躁鬱症患者併發產後憂鬱症住院的護理經驗。護理期間自95年5月19日到95年6月6日，個案入精神科加護病房後，藉觀察、會談及病歷查閱蒐集資料，筆者以五大層面評估，確立護理問題為：高危險性暴力行為－朝向自己、個人因應能力失調－角色轉變、家庭因應能力失調－妥協性。首先積極防範個案自傷，並教導腹式呼吸減輕焦慮及衝動；以關懷、陪伴和個案建立良好護病關係，針對個案所關注的「母職角色」、「育嬰問題」，引導宣洩母職角色轉換之情緒，採漸進式、反覆練習育嬰技能；並與家人溝通，調整彼此期待，協助家庭成員表達關懷與需求，提供後續照顧資源，找出共同照顧嬰兒方式。結果個案未再出現自傷行為，可接受母親角色，家庭成員可承諾共同照顧嬰兒的責任與擬定照顧嬰兒的因應策略。95年6月6日轉急性病房，6月29日出院，持續3個月電話追蹤，其情緒穩定，勝任育兒工作，對目前的生活感到充實滿意。

關鍵字

產後憂鬱症 ； 初為人母 ； 角色轉變

並列摘要

This report documents the nursing experience of working with a primipara, who was diagnosed primarily with Bipolar Disorder and Postpartum Depression. The patient was hospitalized in the psychiatric intensive care unit from May 19, 2006 to June 6, 2006. On the basis of observations of the patient's behavior, interviews and medical record, the following conclusions were drawn. The patient was extremely violent, especially toward herself. Indeed, her self-management and family-management skills had been greatly compromised. Following the diagnosis, a specific treatment plan was developed. First of all, since the patient was extremely violent toward herself, prevention of self-harm was the priority. Second, because the patient was often anxious, it was important to teach her to employ the abdominal breathing technique as a tool to reduce the anxiety. Third, building a good relationship between the nurses and the patient was also a critical component in the treatment plan. This relationship created a comfortable environment in which the nurses could explain to the patient the role of motherhood and infant-caring concerns. Additionally, repeated role-plays in different scenarios were carried out. Finally, the patient's family members were critical to her recovery. The nurses assisted with communication skills, including how to express concerns appropriately and address each other in a respectful manner. They also provided information on resources that could be enlisted in taking care of the infant, and helped the family members to find a way to share the responsibility. As a result, the patient no longer had intentions of self-harm, and was able to play the role of mother. The family members also laid out a specific plan to share the responsibility of taking care of the infant. As a result, the patient was able to transfer to the intensive care unit on June 6, 2006, and was released from the hospital on June 29, 2006. In the course of three months of phone interviews the patient said that she had been feeling stable since the release and become better at taking care of her infant. More importantly, she felt that life was very fulfilling.

並列關鍵字

postpartum ； depression ； primipara ； role-play