利用藝術治療，協助一位新生兒之父母面臨其死亡之護理經驗

Nursing Experience Using Art Therapy With Parents Facing the Death of a Newborn

當新生兒遭遇疾病威脅需住院治療，對父母是一大壓力，倘若父母又需面臨新生兒瀕臨生命終了，這樣的突發衝擊對父母而言將帶來莫大的哀傷及失落，進而造成家庭運作功能紊亂。本篇個案旨在描述一位鏈球菌感染新生兒及其父母面臨死亡之護理經驗，筆者於2019年4月5日至2019年7月6日擔任主要照顧護理師，藉由直接照護、觀察與父母親互動收集資料，運用整體系統性評估進行資料分析，確立個案健康問題有：（一）現存性感染：與B型鏈球菌（group B streptococcus）感染有關、（二）組織灌流改變：因感染敗血症引起腦、心、肺、腎等多重器官灌流不足、（三）照顧者哀傷：因面臨新生兒死亡。筆者在個案生命末期階段，照護以維持身體功能及完整性為主，希冀維持皮膚完整性及容貌，且利用藝術治療引導家屬在製作與個案的回憶錄、書寫日誌、與參與陪伴之中鼓勵表達其內在情緒，由否認崩潰的哀慟之中轉為面對個案生命終了的事實。死亡是一個難以啟齒的議題，希冀藉此護理經驗提供臨床護理人員照護此類個案之參考，展現護理即是藝術之美，達到全人、全家之護理目標，協助個案渡過此危機，維持家庭功能的正常運作。

When a newborn requires immediate hospitalization due to a potentially life-threatening situation, parents face a sudden and significant increase in stress. This situation and the potential loss of their child will bring great grief and loss to the parents, which may lead to conditions that foster dysfunctional family dynamics. This article describes the author's experience providing hospice care to a dying infant with a group B streptococcus infection in the neonatal intensive care unit. The author served as the primary care nurse from April 5th to July 6th, 2019. Data were collected during direct care provision, observations, and interactions with parents, while overall systemic assessments were used in analysis to establish that the health problems of the case were: (1) existing infection: related to group B streptococcus; (2) ineffective tissue perfusion: insufficient perfusion of multiple organs, including brain, heart, lung, and kidney, due to sepsis infection; and (3) caregiver grief: facing the death of a newborn. Nursing care provided to the patient included maintaining individualized physical functions and retaining physical integrity during the end-of-life period. The nursing care provided to the parents included the use of art therapy to encourage them to express their inner emotions through the writing of memoirs and diaries and their participation in companionship. This intervention was designed to help the parents transition from the grief of denying the collapse to the fact that their baby had died. As Taiwanese culture typically avoids discussions of death, the nursing experience described in this article may provide a reference for caring for similar patients. This article highlights the beauty of nursing through art therapy, demonstrates the achievement of whole-person and family-centered nursing, shows how the case was successfully helped through the crisis, and illustrates how normal family functions may be maintained.