照顧一位初次妊娠併妊娠糖尿病面臨胎死腹中引產的護理經驗

A Nursing Experience of Caring for a Women with Receiving Induced Labor for Stillbirth Gestational Diabetes

本篇探討一位初次妊振併妊振糖尿病之孕婦，在孕期36週產檢時得知胎兒胎死腹中，歷經引產、失落及調適過程之護理經驗。照護期間自2015年3月20日至23日，利用羅氏適應模式護理評估工具，確認個案有：急性疼痛／與改善陣痛技巧不足有關、哀傷－－失去胎兒／與不知如何處理急性失落有關及自我照護認知不足－－妊振糖尿病／與缺乏相關資源有關等健康問題。藉由建立良好的護病關係、鼓勵表達其感受，適時的陪伴與傾聽，提供保護性環境，增加與家人的互動，並為後續健康照護提供個案妊振糖尿病相關護理指導，增加個案對於疾病自我照護及使其身心靈獲得慰藉。產科護理人員的工作環境較少面對死亡，筆者藉由跨領域合作方式，尋求安寧小組成員之協助，提升心理層面照護之能力，日後若再度面臨相似個案時，能從容面對且幫助個案一同度過哀傷過程。

The article details the nursing experience of caring for a pregnant woman with gestational diabetes. The fetus, which failed to survive during the patient's 36th week of pregnancy, and the patient had to go through the procedure of induced labor, as well as the process of adapting to loss. The nursing period was from March 20 to 23, 2015. With Roy's adaptation model, the author assessed the patient and identified three nursing problems: acute pain due to insufficient skills to control labor pain, grief and maladaptation secondary to loss, and insufficient knowledge about self-care of gestational diabetes and relevant resources. Establishing a therapeutic relationship between the nurse and the patient, encouraging her to express her feelings through adequate companion and listening, providing a protective environment, increasing the patient's interactions with her family, and teaching the patient about nursing care for gestational diabetes increased the patient's self-care ability and supported her psychosocial needs. The obstetric nurses had fewer experiences in facing fetal death, so the author searched for assistance of the hospice team to promote psychological and spiritual care through multidisciplinary coordination. The author hopes that nurses will be able to help patients through The grieving process when facing similar cases in the future.