以Watson關懷理論照護重覆安胎失敗產婦面對周產期失落之護理經驗

The Nursing Experience of Caring for a Woman Undergoing Perinatal Loss After Repeated Failed of Tocolysis by Using Watson's Caring Theory

本文是在描述一位懷孕20週的個案在歷經兩次安胎失敗，此次面臨子宮頸閉鎖不全而入院安胎，因自然破水宣告安胎失敗接受引產之護理經驗。護理期間自2017年2月14日至2017年2月16日。在護理期間運用Watson關懷照護理論為基礎，藉由觀察、會談、身體評估及直接照護方式，進行整體性護理評估，收集個案生理、心理、社會及靈性各層面資料，發現個案在安胎期間因擔憂胎兒健康及擔心安胎失敗，而有「焦慮」的健康問題；也因為安胎期間需絕對臥床休息而出現「舒適型態改變」的健康問題；安胎失敗後接受引產而失去期望中胎兒，出現「哀傷」的健康問題。於護理過程中，筆者藉由良好的護病關係，提供個案安胎之相關資訊，以減輕焦慮。並協助個案維持身體的清潔、適當活動及增進舒適感以減輕活動受限制之不適，利用主動關懷、傷慟關懷技巧及鼓勵個案接受因安胎失敗引產所產生的哀傷情緒，使個案能面對周產期失落及失去胎兒的傷慟情緒。

This paper describes the care experience for a 20-week-pregnant patient. The patient's previous fetus died due to preterm labor; in her current pregnancy, the patient was hospitalized for tocolysis due to cervical atresia. Tocolytics were determined to be ineffective for the patient when spontaneous preterm rupture of the membranes occurred, and the patient received induction. The care period was between February 14 and February 16, 2017. During this period, by applying Watson's caring theory, we collected data through observations, interview, and physical assessment and also conducted a holistic assessment incorporating physical, psychological, social, and spiritual aspects. During tocolysis treatments, the patient was discovered to experience anxiety engendered by her concerns about the health of the fetus and about the possible failure of the tocolytics. In addition, the patient had impaired comfort because she required absolute bed rest. Subsequently, after the tocolytics failed, she received induction and lost the fetus, causing her to become grief-stricken. During the care period, the author developed a favorable relationship with the patient and thus provided her relevant information on tocolysis to reduce her anxiety. In addition, the author assisted the patient in maintaining physical hygiene and in executing appropriate movements to increase her comfort and reduce her discomfort from restrained mobility. Moreover, the author actively cared for and encouraged the patient to accept the grievance caused by the tocolysis failure and the subsequent induction, thereby helping the patient face the perinatal loss.