一位高齡產婦因胎兒染色體異常接受終止妊娠之護理經驗

本文敘述一位35歲的高齡孕產婦，因產檢發現胎兒染色體異常接受終止妊娠之照護經驗。身為高齡產婦同時亦為首次懷孕，對個案的打擊非同小可，故協助個案調適情緒對護理人員是一項挑戰。筆者於2023年2月17日至2月24日，依Gordon十一項健康功能型態進行評估，藉由觀察、會談、溝通與身體評估對個案進行生理、心理及社會層面等評估，發現個案有疼痛、情境性低自尊、哀傷之健康問題。照護過程中運用關懷、傾聽、陪伴及同理心等技巧建立良好信任感與治療性關係，依個案需求提供個別性照護，運用放鬆技巧和呼吸法及非藥物性處置減緩宮縮疼痛；引導個案表達內心的感受及情緒宣洩，鼓勵家人陪伴、交談分享內心感受，導正負面想法，協助個案找回自我價值，改善其情境性低自尊問題；運用「四道人生」協助個案與其家屬自哀慟中走出陰霾，渡過終止妊娠之哀傷過程，接受失去胎兒的事實、重新規劃未來生活，有勇氣面對下一次懷孕。期望藉此護理經驗，做為照護此類個案之參考，以提升專業護理品質。

This article describes the nursing experience of a 35-year-old advanced maternal age women who underwent termination of pregnancy due to fetal chromosomal abnormalities discovered during prenatal screening. Given the advanced maternal age and first-time pregnancy, the impact on the individual was significant, posing a challenge for the nursing staff in assisting the patient in emotional adjustment. Data were collected during the nursing period from February 17th to February 24th, 2023 through observations, interviews, communication, and physical assessments to evaluate the physiological, psychological, and social aspects of the patient. The data were analysed and integrated using Gordon’s Functional Health Patterns to conduct an overall assessment and identify health problems, including acute pain, situational low self-esteem, and grieving. During the care process, techniques such as active listening, companionship, and empathy were employed to establish a sense of trust and therapeutic relationship. Individualized care was provided based on the patient's needs, including the use of relaxation techniques, breathing exercises, and non-pharmacological interventions to alleviate uterine contraction pain. The patient was guided to express inner feelings and emotions, encouraged to have the presence of family members, engage in conversations to share inner feelings, correct negative thoughts, and help the patient regain self-worth and improve situational low self-esteem. The ''Four Principles of Life'' approach was utilized to assist the patient and her family in emerging from mourning, navigating through the grieving process of pregnancy termination, accepting the loss of the fetus, and reimagining their future life with the courage to face another pregnancy. It is hoped that this nursing experience can serve as a reference for caring for similar cases and contribute to enhancing the quality of professional nursing care.