以周產期安寧照護概念協助一位因胎兒異常選擇終止妊娠孕母的護理經驗

Nursing Experience of Caring a Woman undergoing Termination of Pregnancy for Fetal Anomaly by Applying Perinatal Hospice Concept

本文運用周產期安寧照護概念，照護一位於孕期18週5天因胎兒染色體異常選擇終止妊娠孕母的護理經驗。護理期間自2018年4月15日至4月18日，筆者運用整體性護理評估，以觀察、會談、陪伴、身體評估、直接護理及返家後持續電訪方式收集資料，確立個案健康問題包括疼痛、哀傷功能失常及低自尊。在照護期間依據周產期安寧照護概念提供以家庭為中心的照護。在入院時，結合跨團隊整合性照護，在生產前與個案及家屬共同討論並擬定生產照護計劃，增加對生產過程的掌控感；在待產陣痛時，教導以非藥物方式及維持身體清潔等來緩解陣痛並促進舒適感；在生產後，協助家庭成員共同執行親職活動，完成為人父母角色；在胎兒死亡後，協助安排喪禮及哀傷諮詢，並在返家後以電訪方式持續追蹤並寄送慰問卡關懷，幫助個案表達及宣洩情緒並度過哀傷，最終接受胎兒去世的事實並恢復母性信心。建議醫院應提供個案在門診確立診斷時，立即啟動一個以家庭為中心的跨團隊周產期安寧照護計劃，提供婦女及其家庭相關的協助，進而落實周產期安寧照護。

This article describes the nursing experience based on the concept of perinatal hospice to assist the mother who chooses to terminate the pregnancy due to chromosomal abnormalities of the fetus at 18 weeks and 3 days. The care period was from April 15th to April 18th, 2018. The author collected data through observation, interviews, companionship, physical assessment, direct care, and telephone interview after returning home. The health problems were identified as (1) pain; (2) grief; and (3) low self-esteem. During the care period, family-centered care was provided based on the concept of perinatal hospice. Upon admission, multiple teams discussed with the mother and the husband to design a delivery care plan for increasing the sense of control over the delivery process. When the mother begins to feel labor pain, non-pharmacological pain management methods and body cleanliness maintenance were used to relieve labor pain and promote comfort; after birth, the nurse assisted family members with completing parental activities together; after the death of the fetus, assisted family with arranging funeral and grief consultations. After returning home, we continued to follow up the mother by telephone interview and sent a condolence card to help the mother express and vent her emotions and grieve. Finally, the mother accepted the fact that the fetus died and restored maternal confidence. It is recommended that the hospital should provide mother and their families a family-centered perinatal hospice care by multi-disciplinary team when the diagnosis was confirmed in the outpatient clinic, and to provide needed assistance to implement perinatal hospice care.