運用羅氏理論於一位高齡初孕婦住院安胎的護理經驗

Application ofthe Roy's Adaptation Model for an Advanced Matemal Age Pregnant Woman During Hospitalized Tocolysis

高齡妊娠對懷孕安胎住院之孕婦而言，不僅是一場充滿壓力的歷程，且可能對其生命造成威脅。本文旨在運用羅氏理論探討一位高齡初孕婦住院安胎的護理經驗。筆者以羅氏適應模式進行身、心、靈、社會之完整性評估。確立問題包括：潛在危險性傷害∕與羊膜破裂可能導致流產或早產有關；焦慮∕與安胎結果無法掌握及擔心胎兒健康狀況有關；睡眠形態紊亂∕與醫療環境的改變、注射安胎藥物的副作用及擔憂安胎的結果有關；便秘∕與安胎醫囑臥床休息及環境缺乏隱密性有關。運用羅氏適應模式針對各項問題，提供的護理措施，重點為：（一）監測與促進孕婦與胎兒安全；（二）維持孕婦基本需要的滿足及身體的舒適；（三）陪伴與傾聽以滿足個案心理層面的需求；（四）依據個案對胎兒狀況認知的需要，主動提供正確的訊息；（五）護理人員成功扮演支持、協調、教育者角色；以確實有效減輕個案對安胎住院之壓力，並協助順利度過生理及心理壓力危機，進而提升安胎照護的品質。The advanced maternal age of a pregnant woman during hospitalized tocolysis can not only be a stressful journey, but also a life-threatening situation. The aim of this case study is to explore the nursing experience in caring for a high-risk pregnant woman with advanced maternal age during hospitalized tocolysis. The researcher employed the Roy adaptation model to perform comprehensive assessment of the participant. Problems were identified as follows: risk for injury, which could be related to the abortion or preterm labor resulted from the rupture of membranes; anxiety, which could be related to the uncontrollable outcome of tocolysis and the worry about the health state of the fetus; sleep disturbance, which could be related to the changes in health care environment, the effects of tocolysis drug use, and the worry about the outcome of tocolysis; and constipation, which could be related to bed rest orders and the lack of privacy in the ward. In order to settle each problem, the suggestions to the main nursing management strategy are as follows: 1. monitoring and improving the safety of the expectant mother and the fetus; 2. maintaining he mother's basic needs and body comforts; 3. accompanying and listening to the mother to meet her psychological needs; 4. providing accurate information for the mother based on individual's needs to understand the fetus' conditions; 5. nurses' playing a role of a supporter, a consultant, and an educator to effectively reduce the expectant mother's stress during hospitalized tocolysis. All of the strategies can assist the mother to pass through the physical and psychological risks, and finally to improve the quality of tocolysis care.