運用Watson關懷理論照護一位產婦面臨子宮內胎兒死亡的護理經驗

Application of Watson's Caring Theory to Nursing Care for a Patient with Intrauterine Fetal Death

本文描述一位妊娠21週之產婦，因子宮內胎兒病毒感染，以致胎兒產生水腫、貧血而死亡。胎兒的死亡對母親所產生的生理影響為「疼痛」心理社會方面則包括「預期性哀傷」及「罪惡感」等問題，經由筆者於99年8月15日至99年8月17日擔任個案的主護護理師，出院後進行二次家庭訪視。於此期間，筆者對個案進行深入的觀察及對談，運用Watson關懷照護理論與個案建立良好的信任關係，有系統地使用科學性步驟，掌握問題解決法來做決定、增進並接受個案正向及負向情感的表達，及提供支持性、保護性及矯正性的心理、生理、社會文化及靈性的環境。護理人員在此過程中，與個案在互信的基礎下，除了提供身體照顧及諮商外，亦使個案的傷慟的情緒得以表達，嘗試分享感受與經驗，為哀傷找到合適的處理方法，進而改善其身、心、社會的問題。

This article describes a nursing experience for a patient in the 21st week of pregnancy. The fetus died from a virus infection. Because of the fetal death, the patient experienced not only physical pain but also anticipatory grief and psychological guilt. The nursing period was from August 15 to 17, 2010. Advanced observation and patient interviews were performed during the patient's hospital stay and a couple of times during post-discharge home visits. With the application of Watson's Caring Theory, a trusting and caring nurse-patient relationship was built up. The decision was made based on the systematical and scientific steps for problem solving. The patient was encouraged to express her feelings in both positive and negative ways. The patient was provided with a supportive, protective, and corrective environment in all physical, psychological, social, cultural, and spiritual aspects. In such an interactive process, the patient could obtain physical care and council. Moreover, the patient could ventilate and share personal feelings and the experience of grief, manage her bereavement in a proper way, and further solve the problems she encountered in physical, psychological, and social aspects.