協助一位子宮內胎兒死亡之初產婦適應住院引產壓力的護理經驗

Nursing Experience in Helping a Primipara With Intrauterine Fetal Death Adapt to Labor Induction in Hospital

本文是描述一位飪娠二十六週，因自覺無胎動，經門診超音波發現無胎心跳，確定子宮內胎兒死亡之初產婦，於住院期問引產適應壓力的護理經驗。筆者為個案之全責護士，照護期間自91年3月21日至91年3月28日，應用羅氏適應模式的護理過程與個案建立良好的人際關係後，藉由觀察、會談、身體評估等方式收集資料。在本研究中確立個案的護理問題有：（1）失去孩子的哀傷；（2）失去母職的挫敗感；（3）面對先生感到罪惡不安；（4）面對醫療過程的不信任；（5）引產造成的疼痛。針對其問題，給予的護理重點是：（l）減輕個案及家屬因失去孩子造成的衛擊與壓力；（2）協助個案接受失去孩子的事實；（3）協助個案與先生有良好的溝通，並加弦此支持系統；（4）協助個案接受醫療行為；（5）減輕引產造成的不適。整個住院過程，研究者協助個案面對此壓力事件，在生理調適、自我概念、角色功能及相互依賴各方面不斷適應，進而接受失去孩子的事實，維持健康的自我形象。

This article describes the experience of nursing an outpatient primipara in the 26th week of pregnancy who was not conscious of fetal movement and whose fetus was confirmed by sonography as having suffered intrauterine fetal death to adapt to labor induction as a hospital inpatient. The nursing care lasted between March 21 and March 28, 2002. I (the researcher) tried to use the well established Roy Adaptation Model of Nursing to collect information through observation, interview, and physical assessment. The subject’s nursing problems included: 1 .The sadness of losing child. 2. The frustration of not being able to take on the mother’s role. 3. Feeling evil and sorry when facing her husband. 4. Doubting her course of medication. 5. Pain due to labor induction. In accordance with the situation, the main nursing strategies were: 1. To reduce the shock and pressure for the subject case and her family due to the loss of a child. 2. To help the subject accept the fact of loosing her child. 3. To help the subject and her husband to communicate well and establish support systems. 4. To help the patient to be receptive to medical treatment. 5. To reduce discomfort from labor induction. During the hospitalization, the researcher helped the subject case to face stress and adapt to physiological accommodation, develop a concept of herself, her functional role and interdependence and then accept the fact of losing child and maintain a healthy body image.