運用悲傷輔導於葡萄胎孕婦接受化學藥物治療之護理經驗

A Nursing Experience of Assisting a Critically Ill End-Stage Lung Cancer Patient in Drafting an Advance Directive

本本文探討運用悲傷輔導協助一位葡萄胎高齡孕婦接受子宮內刮除術後，需進一步入院接受化學治療之護理經驗。護理期間2015/5/25至5/30運用Gordon十一項健康功能型態評估護理問題，經直接照顧、會談、觀察及身體評估等技巧收集資料，確立護理問題有健康尋求行為、情境性低自尊、悲傷。使用衛教單張、網路資源和住院全人整合醫療會議，讓個案了解葡萄胎疾病和化學治療注意事項，以提升認知；運用自我肯定訓練、支持、陪伴、及有效溝通，協助其恢復昔日的安全感、歸屬感和成就感；採用悲傷輔導協助其經歷胎兒死亡悲傷過程，接受失落事實，重新適應新生活。期望提供此照護經驗作為醫護人員日後對於異常妊娠個案之悲傷反應更為了解及敏感，及時提供最佳護理之參考。

This article explored a nursing experience of providing grief counseling to a pregnantwoman with hydatidiform mole to undergo dilation and curettage (D & C), andhospitalization for chemotherapy. The nursing period lasted from May 25th to May 30th,2015. With Gordon’s 11 Functional Health Patterns as an assessment framework, data wascollected by direct care, conversation, observation and physical assessment, the patientwas confirmed to have health-seeking behaviors, situational low self-esteem, and grief.During the nursing period, the patient’s cognition on the nature of hydatidiform mole andchemotherapy safety precautions had been increased through the introduction of healtheducational pamphlet, online resources, and holistic integrative medical conferences; torestore a sense of security, belonging, and accomplishment through assertiveness training,support, companionship, and effective communication; and to facilitate the acceptanceof prenatal loss and adaptation to new life by providing grief counseling. This nursingexperience could serve as a reference for other nurses to be more understanding and sensitiveto the grief reaction of patients with abnormal pregnancy. (Tzu Chi Nursing Journal, 2017;16:6, 117-126).