運用悲傷輔導於葡萄胎孕婦接受化學藥物治療之護理經驗

A Nursing Experience of Providing Grief Counseling to a Pregnant Patient with Hydatidiform Mole to Undergo Chemotherapy

朱君蕙(Chun-Hui Chu)；陳瑩倢(Ying-Chieh Chen)

悲傷輔導 ； 葡萄胎 ； 化學治療 ； chemotherapy ； grief counseling ； hydatidiform mole

志為護理-慈濟護理雜誌

16卷6期（2017 / 12 / 01）

117 - 126

繁體中文

本文探討運用悲傷輔導協助一位葡萄胎高齡孕婦接受子宮內刮除術後，需進一步入院接受化學治療之護理經驗。護理期間2015/5/25至5/30運用Gordon十一項健康功能型態評估護理問題，經直接照顧、會談、觀察及身體評估等技巧收集資料，確立護理問題有健康尋求行為、情境性低自尊、悲傷。使用衛教單張、網路資源和住院全人整合醫療會議，讓個案了解葡萄胎疾病和化學治療注意事項，以提升認知；運用自我肯定訓練、支持、陪伴、及有效溝通，協助其恢復昔日的安全感、歸屬感和成就感；採用悲傷輔導協助其經歷胎兒死亡悲傷過程，接受失落事實，重新適應新生活。期望提供此照護經驗作為醫護人員日後對於異常妊娠個案之悲傷反應更為了解及敏感，及時提供最佳護理之參考。

This article explored a nursing experience of providing grief counseling to a pregnant woman with hydatidiform mole to undergo dilation and curettage (D & C), and hospitalization for chemotherapy. The nursing period lasted from May 25th to May 30th, 2015. With Gordon's 11 Functional Health Patterns as an assessment framework, data was collected by direct care, conversation, observation and physical assessment, the patient was confirmed to have health-seeking behaviors, situational low self-esteem, and grief. During the nursing period, the patient's cognition on the nature of hydatidiform mole and chemotherapy safety precautions had been increased through the introduction of health educational pamphlet, online resources, and holistic integrative medical conferences; to restore a sense of security, belonging, and accomplishment through assertiveness training, support, companionship, and effective communication; and to facilitate the acceptance of prenatal loss and adaptation to new life by providing grief counseling. This nursing experience could serve as a reference for other nurses to be more understanding and sensitive to the grief reaction of patients with abnormal pregnancy.

1. Cote-Arseanult, D.(2007).Threat appraisal, coping, and emotions across pregnancy subsequent to perinatal loss.Nursing Research,56(2),108-116.
2. Diaz, J.,Thomas, M. B.,Paz-Pabon, C.,Hernandez, E.(2012).Methotrexate on a 21-day cycle for low-risk gestational trophoblastic neoplasia.The Journal of reproductive medicine,57(9-10),411-414.
3. Mashiach, R.,Anter, D.,Melamed, N.,Ben-Ezra, M.,Hamama-Raz,Y,Meizner, I.(2013).Psychological response to multifetal reduction and pregnancy termination due to fetal abnormality.The Journal of Maternal -Fetal Neonatal Medicine,26(1),32-35.
4. Rubin, R.(1984).Maternal identity and the maternal experience.The American Journal of Nursing,84(12),1480.
5. White, N.,Maxwell, C.,Michelson, J.,Bedell, C.(2005).Protocols for managing chemotherapy-induced neutropenia in clinical oncology practices.Cancer Nursing,28(1),62-69.
6. 內政部(2015，5月29日)．內政部統計年報．取自 http://sowf.moi.gov.tw/stat/year/list.htm。
7. 田聖芳,張芳維(2012).實用婦科護理.臺北市:華杏.
8. 吳蕙如,劉秀琴(2012)。照顧一位初次妊娠護理人員面臨胎死腹中之護理經驗。助產雜誌，54，83-92。
9. 李文琮,李耀泰,陳福民,郭宗正(2013)。懷孕試驗陰性的葡萄胎。中華民國婦癌醫學雜誌，1，100-107。
10. 李從業（校閱）(2009).實用產科護理學.臺北:華杏.
11. 李開敏（譯）(2004).悲傷輔導與悲傷治療.臺北:心理.
12. 李耀泰,陳福民,林大欽,朱益志,趙德讓,郭宗正(2006)。低人類絨毛膜促性腺激素的檢視。中華民國婦癌醫學雜誌，2，33-40。
13. 李耀泰,陳福民,郭宗正(2013)。以何種Methotrexate方法治療低風險滋養層疾病最佳。中華民國婦癌醫學雜誌，1，92-99。
14. 周雨樺,蕭伃伶,何美華,孫瑞瓊,林淑玲,黃樹欽,徐莞雲(2014).產科護理學.臺北市:新文京.
15. 陳雅萍(2014)。照顧一位安胎失敗之產婦面臨周產期失落哀傷歷程之護理經驗。長庚護理，25(2)，204-212。
16. 蔡佩臻,張嘉玲,林梅香,賀倫惠,邱綉玲(2015)。檢視不同漱口溶液對移植術後病人口腔炎之應用及成效。系統性文獻回顧，26(1)，13-22。
17. 鄧碧玉（譯）(1994).自信訓練手冊.臺北:遠流.