| 中文摘要 |
本文敘述一位初產婦面臨引產失敗而行剖腹生產的照護經驗，在期望自然分娩的待產過程因產程延長，產痛難以忍受及產程進展的不確定，喪失信心進而產生放棄與是否繼續支撐下去的抉擇。筆者以Gorden的健康功能評估及照顧期間的觀察溝通實錄，歸納出主要健康問題，分別為：疼痛不適、焦慮、潛在高危險性感染以及抉擇衝突等；以生產護理支持的理念，結合陪產者（配偶）提供直接護理包括個人衛生的維持、協助變換姿勢、撫觸及按摩等，以促進舒適保持其體力；給予訊息支持如：持續指導呼吸鬆弛法，告知產程進展等；也幫助情緒支持如：同理及接受疼痛反應、維護隱私、支持及鼓勵；結果雖未能使產婦免除產痛，然在產程進展緩慢的情境中，仍努力把持自我。最後因產程遲滯而行剖腹生產，但醫護人員持續的訊息支持，幫助產婦減少待產過程做抉擇的衝突及面對與期望不同的手術生產，能自我調適。This case study describes a nursing care experience for a nidlipara. The nullipara faced the stress from prolonged labor, including the unbearable pain caused by labor, and the uncertainty of the labor progress. The nullipara had to make the decision whether to undergo Cesarean section instead of normal spontaneous delivery. The author, also the primary nurse for the nullipara, assessed the nullipara’s health conditions using Gorden, s health function assessment methodology as well as her observation notes during the nursing period and identified four problems: pain, anxiety, a potentially high-risk of infection and the mental conflict about the choice of delivery method. The author provided direct care (for example, maintaining personal hygiene, assisting with position changes, and massages), informational support (such as instructing in breathing/relaxation methods and informing about progress), and emotional support (such as assuring privacy, accepting the nullipara’s pain reaction, and providing encouragement) to the nullipara based on the concept of nursing support. Due to the nursing efforts from the author, the nullipara successfully adjusted herself during the prolonged labor progress and overcame her mental conflict while choosing Cesarean section as the delivery method, which was not according to her delivery plan. The nullipara considered this nursing experience to be positive and satisfying. The author hopes to contribute to improving the nursing quality for similar nulliparas by sharing this rewarding experience. |
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