協助一位經歷產後大出血危機婦女及其家庭因應之加護經驗

The Nursing Experience of a Postpartum Hemorrhage Patient and Her Family Coping in the Intensive Care Unit

本文探討一位產後大出血行子宮切除術後因持續失血二度入手術室病人之加護照護經驗，護理期間於2018年5月24日至31日，以Gordon評估工具確立高危險性傷害、害怕及家庭因應能力改變等健康問題，照護期間結合多專科團隊改善生理問題，另察覺個案歷經死亡威脅等原因導致害怕擔憂以及案夫面對妻子緊急致命病況和家庭照顧問題產生因應失衡，藉提供完整資訊並整合家庭支持系統，幫助建立親子連結，協助共同度過個體和家庭的衝擊與危機。重症護理優先處理急性問題，因產後婦女的角色和荷爾蒙改變有特殊的生心理變化，對於重症護理師而言顯較困難，建議新增產科重症課程增進護理人員臨床照護能力，並期望以視訊進行重症與產、兒單位跨科別共同查房，真正做到以家庭為中心的重症照護。

This study explored the caring experience in the intensive care unit (ICU), where the subject went through hysterectomy due to Postpartum Hemorrhage (PPH) and was sent to the operating room twice for continuous blood loss from May 24 to May 31 in 2018. Gordon's Functional Health Patterns was applied to evaluate and identify health problems, including injury risk, fear, family response, etc. During the care period, ICU team integrated cross-departmental efforts to mitigate the patient's physiological conditions, however the team realized the patient could not address psychological burden due to the horror caused by the death threat, her husband's adaptability to the fatal illness and family care issue. Therefore, complete information and family supportive system was provided to help building parent-child relationship and overcoming difficulties. The critical care is primarily to address emergent issues. Postpartum women usually experience physiological and psychological changes, and thus it is suggested that obstetric critical care program should be introduced to increase nurses' caring ability, with joint ward inspection conducted via video by the departments of Critical Care, Pediatrics and Obstetrics, as to fulfill the family-centered critical care.