照護一位COVID-19陽性產婦所分娩的早產兒之加護護理經驗

An Intensive Nursing Experience of Caring a Preterm Infant Birthed by a Mother Infected with COVID-19

10.6740/NTUHJN.202401_20(1).0011

蔡采軒(Cai Syuan Tsai)；陳玉蓮(Yu-Lien Chen)；范圭玲(Guei-Ling Fann)

新型冠狀病毒 ； 以家庭為中心的護理 ； 通訊設備裝置 ； communication device ； COVID-19 ； family-centered care

臺大護理雜誌

20卷1期（2024 / 01 / 01）

113 - 125

繁體中文;英文

本文描述照護一位受到SARS-CoV-2感染之產婦所分娩的30^(+6)週早產兒之加護護理經驗。COVID-19自2019年12月開始肆虐全球，造成全民恐慌。個案為本單位收治首位確診產婦所分娩的早產兒，由於各器官不成熟引發的早產兒併發症，加上曾與確診者密切接觸需隔離於新生兒加護病房負壓隔離室，使照護與治療增添難度。此外，案母因病情需要隔離於加護病房負壓隔離室，案父亦隔離於家中，兩位皆因無法探視個案而焦慮無助，引發筆者動機，期望在照護過程提供發展性照護，減緩案父母焦慮，滿足個案及案父母的需求。護理期間為2021年6月21日至2021年6月27日。藉由系統性身體評估、觀察法以及與家屬會談收集資料。確立健康問題有：氣體交換障礙、混亂性嬰兒行為、照顧者角色緊張。除提供生理層面的護理措施外，也針對早產兒發展需求給予適當的視覺和聽覺刺激、寧握、擺位等發展性照護，並以同理心關懷案父母因擔心個案感染SARS-CoV-2與早產帶來的壓力。雖然探訪限制讓案父母無法進到負壓隔離室探視個案，使親子關係建立受阻，但藉由視訊通話能協助案父母了解個案病情進展、學習早產兒照護、促進親子互動。建議防疫期間，能廣泛運用電子裝置、通訊軟體，持續電訪關懷，以維持親子依附關係之建立，達到以家庭為中心的護理核心理念。

This article describes the intensive nursing experience of a preterm infant born at 30^(+6) weeks of gestation to a mother infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronavirus disease (COVID-19) first occurred in December 2019, causing panic among people and healthcare providers. This article describes the case of a newborn who was the first preterm infant delivered by an infected mother in our unit. Complications owing to immature organs, coupled with the policy of the negative-pressure isolation room, made it more difficult to provide treatment and care. Moreover, the mother was admitted to the intensive care unit for critical care. The father was unable to visit his wife and child at the hospital owing to visiting restrictions. The parents anxiety and helplessness in that situation motivated the author to write this report to provide developmental care and relieve parents' anxiety. Nursing care was provided from June 21 to 27, 2021. Data were collected through systematic physical examination, observation, and interviews, which revealed three major problems: (1) impaired gas exchange, (2) disorganized infant behavior, and (3) caregiver role strain. In addition to providing daily physical care, we also offered individualized developmental care, such as appropriate visual and auditory stimulation, developmental positioning, and containment during the entire nursing period. Moreover, providing supportive care to parents is important because they are stressed about the health conditions of their premature child and are concerned that their child may be infected with SARS-CoV-2. Owing to visiting restrictions, parents cannot enter a negative-pressure isolation room, which makes it difficult to establish a bond between parents and children. Nevertheless, through video calls, we helped parents understand the progression of the disease, learn about the preterm infant's daily care, thereby enhancing parent-child interaction. To meet the core concept of family centered care, electronic devices and communication software can be used to establish parent-child bond during the COVID-19 pandemic.