一位高齡孕婦面臨乳腺炎及終止妊娠的照護經驗

The Nursing Experience of Caring for a Senior Pregnant Woman with Mastitis Ending Pregnancy

本文為照顧一位高齡孕婦在懷孕初期復發乳腺炎，且發現胎兒異常必須終止妊娠的護理經驗。護理期間自2012年6月5日至6月15日，運用直接照護、觀察、會談及病歷查證等方式收集資料，依生理、心理、社會及靈性層面進行整體性護理評估，確立個案其主要的健康問題有疼痛、睡眠型態紊亂及哀傷。照護過程中與個案建立良好的護病關係，滿足其個別的需求外，應用穴位按摩、轉移注意力來緩解乳腺炎造成的疼痛；利用音樂聆聽、集中護理及環境安排來改善睡眠問題；運用同理心接納個案之情緒反應，並藉由有效溝通、傾聽技巧及家人支持和陪伴，佐以悲傷輔導理論，協助個案渡過終止妊振之哀傷過程，勇敢面對失去胎兒的事實；運用支持系統，協助個案與其家屬體驗失落的現實；希望藉此個案的經驗，提供護理同仁日後照顧此類病人的參考。

This report describes the nursing experience of caring for a senior pregnant woman who had recurrent mastitis and underwent a termination of pregnancy secondary to fetal abnormality. The nursing period lasted from June 5 to June 15, 2012. The data were collected through direct care, observation, interview, and medical record reviews. A comprehensive nursing assessment that included physical, psychosocial, and spiritual dimensions was completed. The main identified nursing problems were pain, sleep disorder, and grief. During the care period, the author attempted to establish a good , therapeutic patient-nurse relationship to fulfill the patient's individual needs; apply acupressure and divert her attention to ease her mastitis pain; and improve sleep quality by having the patient listen to music, providing focused care, and arranging an appropriate environment. With applied bereavement support theory, the author accepted the case's emotional reaction with empathy, and assisted her with going through the process of grief through effective communication, attentive listening, and family companionship and support. Having a support system helped the case and her family cope with the experience of fetal loss. The author hopes that this case presentation may be used as a reference for nurses taking care of similar patients.