照顧一位頭部外傷嬰兒瀕臨死亡之護理經驗

Nursing Experience on Caring a Dying Baby with Head Injury

本文旨在描述協助一位頭部外傷嬰兒及其母親面對嬰兒瀕死之護理經驗。筆者在2010年11月30日至2011年2月12日於新生兒加護病房照護期間，照護一位好不容易受孕的母親，在面臨同意拒絕積極治療且簽署不施予心肺復甦術之瀕死愛子的哀傷與無助，使筆者於照顧的過程中深刻感受其遽失親人的悲痛。應用護理過程及Davidson的悲傷過程，藉由身體評估、傾聽及會談等方式，收集主客觀資料，確立個案及案母的主要護理問題為：自主性換氣障礙、組織灌流失效（特定型態：腦）及哀傷。筆者與醫師團隊提供瀕死嬰兒緩和療護，應用巢穴及寧握護理的技巧，減少身體傷害，並發現母親面臨親兒死亡出現哀傷反應，運用人性化的關懷、傾聽、支持之照顧精神，與案母建立互信關係，協助她表達哀傷情緒、面對親兒死亡、調適失落的感受。筆者期待透過本次照護瀕死之重症兒童應用緩和療護的經驗，並協助案母渡過哀傷的過程，提供護理人員未來在照顧相似病童的臨床情境照護之重要參考。

The aim of this paper was to describe a nursing care experience concerning an infant with head injury and his mother faced with her dying baby. The author contacts baby’s mother during the period of pregnancy to the mother in facing with her baby refused aggressive treatment and signed a document concerning do not resuscitate in the neonatal intensive care unit from November 30, 2010 to February 12, 2011. During this period of nursing care experience, the author possesses a deep sense by means of going through the baby’s mother in facing a huge impact due to lost her baby. In the present study, methods of nursing application process and Davidson's grief process were used. In addition, data information was collected through systematic physical examination, observation, listening, and interview. The mainly nursing problem of this case was certified as followed: autonomy ventilation disorders, tissue perfusion failure (specific types for the brain), and sad. The application skills including nesting and holding care were provided by the author and physician to reduce body’s injury of mother. Moreover, grief reaction was found in mother in facing the process of child death. In addition to this, the author used the following principles including humane care, listening, and spirit support to achieve and to build trust from mother. As mentioned above, these principles are helpful for the mother in expressing their grief emotions, facing the situation of baby death, and adapting her lost feelings. In conclusion, by means of our severe acute children's palliative care experience, we also expected and look forward to providing our nursing care experience to those clinical nurses in facing and dealing with those similar situations and cases in the future.