運用Swanson關懷理論照顧一位周產期憂鬱孕婦之護理經驗

Nursing Experience Using Swanson’s Caring Theory to Care for A Pregnant Woman with Peripartum Depression

本篇描述一位初次懷孕且是婚外情的角色，在面臨是否繼續懷孕的矛盾情緒與認同母親角色的過程中，發生周產期憂鬱的護理經驗。護理期間2021年9月22日至2022年2月25日，藉由觀察、會談、傾聽、關懷與陪伴等方式收集資料，依生理、心理、社會與靈性四大層面評估、確立個案有三項主要健康護理問題有：無效性因應能力、舒適型態改變及焦慮。護理過程中以Swanson關懷照護理論的五大過程，經由「了解」、「在旁陪伴」、「為她做某些事」、「使她能夠」、「維持信念」，先建立護病關係以增進信任感，提供護理指導與心理支持，肯定個案此次懷孕的歷程；運用簡式健康量表(Brief Symptom Rating Scale,以下簡稱BSRS-5)又稱為「心情溫度計」來評估個案憂鬱情緒的心理健康照護需求，教導個案如何善用社會支持系統來緩解因懷孕所導致的壓力，與運用醫療團隊的互助合作，改善懷孕所造成的生理不適問題，持續的給予個案關懷與照護，讓個案以正向態度面對周產期憂鬱。建議護理人員應加強接受心理支持及關懷的相關訓練，讓護理人員能擔任「早期發現、早期干預、早期協助」的角色。期待藉此個案照護經驗分享做為往後其他同仁臨床照護之參考。

This article describes the nursing experience of a woman who was pregnant for the first time and had an extramarital affair. She had conflicting emotions about whether to continue the pregnancy and the process of identifying her role as a mother. She experienced perinatal depression. During the nursing period from September 22, 2021, to February 25, 2022, data were collected through observation, interviews, listening, care, companionship, etc. Three main points were used to evaluate and establish the case based on the four major levels: physical, psychological, social, and spiritual. Healthcare issues included ineffective coping, altered comfort patterns, and anxiety. The five major processes of Swanson’s caring theory were used in the nursing process. Through“understanding,”“accompanying her,”“doing something for her,”“enabling her,”and“maintaining faith,”the nursing relationship was established to enhance trust. The patient received nursing guidance and psychological support for her pregnancy journey. The Brief Symptom Rating Scale, also known as the“mood thermometer,”was used to assess the patient’s mental health and depression. To provide care needs, the patient was taught how to make good use of the social support system to relieve the stress caused by pregnancy, mutual assistance and cooperation with the medical team was provided to improve the physical discomfort caused by pregnancy, and care was continually provided for positive development. Regarding attitudes despite perinatal depression, nursing staff should strengthen their training in psychological support and care for“early detection, early intervention, and early assistance.”We look forward to sharing this case care experience as a reference for the clinical care of other colleagues in the future.