照顧一位乳癌初產婦因胎兒異常面臨終止妊娠之護理經驗

Nursing Experience of Caring for a Primiparous Woman with Breast Cancer While Facing Termination of Pregnancy for Fetal Abnormality

10.29494/LN.202103_22(1).0004

陳慧怡(Hui-Yi Chen)；張詒舒(Yi-Shu Chang)；賴芊孝(Chien-Hsiao Lai)

終止妊娠 ； 胎兒異常 ； 乳癌 ； termination of pregnancy ； fetal abnormality ； breast cancer

領導護理

22卷1期（2021 / 03 / 01）

38 - 53

繁體中文

本篇報告是描述照護一位乳癌初產婦治療後一年意外懷孕，卻面臨胎兒異常需終止妊娠之護理經驗，因個案喜悲情境之轉換而無法調適，因而引發筆者想要深入探討及介入照護之動機，護理期間自2016年10月10日至2016年10月15日護理期間，運用Gordon十一項健康功能型態進行整體性護理評估，藉由實際參與照顧、觀察、陪伴、傾聽、會談等方式收集資料加以分析，確立個案主要健康問題有：（1）疼痛／缺乏因應生產的宮縮不適痛；（2）焦慮／與對引產過程不了解；（3）哀傷／與面對胎兒異常必須終止懷孕的失落有關三項健康問題。深知個案面臨癌後與懷孕雙重壓力，希望藉由參與此次照護，除了能協助個案緩解引產前後生理的不適之外，亦能協助其調適痛失胎兒之情緒，幫助個案順利度過此次令人悲慟與惋惜的歷程。建議產科單位可建置個案管理師，以完善地提供產前到產後持續性關懷服務，建立出院追蹤系統，也建議產科護理人員須將參與哀傷輔導之教育訓練課程列為常規，以提高哀傷輔導之護理能力。筆者以此經驗分享提供產科醫護理人員於日後臨床照護失去胎兒的家庭時的之參考，幫助更多失去胎兒的家庭一同渡過哀傷，迎向未來。

This article details a nursing experience of a primiparous woman with breast cancer who also faced termination of pregnancy due to fetal abnormality after treatment for a year. The specific case's inability to adjust her psychological problems motivated the author to explore this topic. The nursing period initiated from October 10th to 15th in 2016. By assessing the individual's case with ＂Gordon 11 Function Health Patterns＂ and practically taking part in the process of the case study with care, observation, accompany, listening and personal interviews, the author had collect information and analyze them. The nursing problems hence identified include: (1) Pain - The lack of uterine discomfort during contraction, (2) Anxiety - The lack of knowledge of labor induction, (3) Grieving - The sorrow after termination of pregnancy due to fetal abnormality. The author truly understand the case's double pressure of post-treatment recovery and pregnancy - hope by taking care of the individual case - to help alleviate the case's stress and discomfort before and after the labor induction. Furthermore, the author hopes to improve the case's emotional adjustment after the loss of her baby, helping her successfully went through those three types of hardship. In order to comprehensively provide constant antenatal and postnatal care, the nomination of a case manager and the tracing system after the patient discharge from hospital are highly recommended. Additionally, in order to enhance the ability of grief counseling, the regular counseling training courses relating pregnant women with cancer for nurses in obstetrics & gynecology are also recommended. By providing the nursing staff in obstetrics & gynecology with this nursing experience, the author hopes this can become a reference for others when taking care of the patients with cancer, help the families of the patients gone through the pain and hence look forward to the future.

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