一位羊膜膨出初產婦安胎失敗面臨周產期失落之護理經驗

A Nursing Experience of a Primipara with Protruding Amniotic Membrane Experiencing a Perinatal Loss after Tocolysis Failure

10.6647/CN.202006_27(2).0009

黃詩婷(Shih-Ting Huang)；何倩儀(Cian-Yi He)

子宮頸閉鎖不全 ； 安胎 ； 周產期失落 ； Cervical Insufficiency ； tocolysis ； Perinatal Loss

彰化護理

27卷2期（2020 / 06 / 01）

46 - 59

繁體中文

本文旨在描述運用羅氏適應模式照護一位羊膜膨出的初產婦安胎失敗面臨周產期失落之護理經驗。筆者於護理期間自2017年2月20日至2月27日，藉由直接護理、觀察、會談方式進行資料收集並運用羅氏適應模式進行整體性評估，確立個案問題有焦慮、舒適型態改變及哀傷。針對焦慮問題，藉由傾聽、溝通以瞭解個案內心感受，教導早產徵兆的自我判斷，增進自我控制力，並主動提供胎兒健康狀況之訊息，以及教導放鬆技巧以降低其焦慮；對於舒適型態改變問題，向個案澄清臥床休息的定義，教導並協助於床上執行等長運動及關節運動，緩解因臥床休息造成的不適；周產期失落引發的哀傷問題，藉由加強陪伴、鼓勵抒發情緒感受，提供新生兒的腳印卡片作為思念的物品，協助個案度過哀傷過程。因臨床工作繁忙，此類個案心靈層面的問題往往易被忽略，若未能得到適當的照護，將可能造成個案日後夫妻關係及為人母親角色的不良影響。經由此個案之照護經驗，筆者建議可藉由舉辦悲傷輔導或是溝通技巧等在職教育課程以提升護理人員靈性照護能力、醫療機構針對經歷周產期失落個案納入居家管理系統，並設立電話諮詢管道以及家庭支持團體以提供個案情緒抒發管道。期望藉此經驗為護理人員臨床實務提供有價值的參考。

This study aims to share a nursing experience of using a Roy's adaptation model to care a primipara with protruding amniotic membrane experiencing a perinatal loss after tocolysis failure. The data was collected through direct care, observation and interviews during the nursing period from 20 February to 27 February 2017. And Roy's adaptation model was used for a comprehensive assessment to identify three major problems of this case: anxiety, changes in comfort status, and grief. For the anxiety problem, the author tried to fully understand the patient's inner feelings with considerate listening and communication. In order to help the case improve self-control ability, the author also taught the case how to self-judge the signs and symptoms of preterm labor. Proactive providing fetal-health information and relaxation-techniques training are also good approaches for the case to release anxiety. For the problem of comfort statues changes, the author not only helped the case to clarify the definition of bed rest but also assisted the case in performing isometric and joint exercises in bed to alleviate the discomfort caused by bed rest. As for the grief problem caused by the perinatal loss, strengthening company, encouraging to express emotions and providing a newborn's footprint card as a gift are all good methods to support the case to get through tough times. Due to the heavy nursing workload, the spiritual issues of these kinds of cases are easily ignored. However, there will be a negative impact on couple relationship or on the role of being a mother in the future. Based on the nursing experience of this case, the author suggests that on-job-training of grief counselling or communication skills can be used to improve nurse's spiritual care ability; and the cases undergoing perinatal loss should be incorporated into the home management system of medical institutions; moreover, setting up a telephone consultation channel and family support groups can also provide an approach for the cases to express emotions. I hope to use this experience to provide valuable reference for clinical practice of nursing colleagues.

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