[[alternative]]A action research use of Bereavement Services to improve the care process of termination women

[[abstract]]終止妊娠議題不是一個個案、一個家庭、一個醫院的問題，這個問題普遍存在人們的周遭，若無法妥善處理可能引發產婦心靈創傷、家庭對失落事件難以承受、甚至導致醫病之間關係緊張及糾紛。目前國外對於終止妊娠照護已達全面性以家庭為中心的照顧品質，在國內此議題也逐漸受到重視。本研究之目的為：運用傷慟關懷服務改善終止妊娠婦女照顧流程，本研究設計採用參與式行動研究法，在桃園某醫學中心產房邀請醫療團隊(包含醫師、護理師、心理師、社工師、志工、葬儀社人員...等)共同進行終止妊娠婦女照顧改善活動。研究過程根據四個階段來設計：包含「現況問題陳述與界定」、「尋找合作夥伴與擬定行動策略」、「執行改善活動」、「評值改善後成效」。經由現況調查將照顧問題區分為人、事、物三方面，擬定三項行動策略，策略一為引發動機使「人員觀念內化、技能提升」，策略二為「工具豐富化」，修訂多項表單（「終止妊娠衛教手冊」、「終止妊娠關懷表」、「終止妊娠追蹤表」）與製作相關工具（胎兒籃、胎兒包巾、多功能車、及待產室環境營造），策略三為「照顧流程優質化」，將照顧流程從現況住院中醫療與護理為主的照顧，延伸至住院前、中、後連續性且跨團隊的照顧服務。結果發現實務經驗分享可提升護理師對終止妊娠照顧動機、跨領域團隊合作可減輕護理師工作壓力；完整的住院前衛教，有助於醫療過程與婦女和胎兒告別預先做好準備，工具與表單的修訂及增設，提供人員執行作業順暢度。運用改善後流程照顧終止妊娠婦女時，多次感受到婦女對護理師貼心舉動的感謝，且婦女在為胎兒準備玩具、衣物過程中，亦經歷為人母親的親職角色，因為「能為孩子做些事情」減輕內心難過與愧疚，經歷悲傷任務，並由全面性照顧中得到心靈撫慰，本研究結果可做為終止妊娠婦女照顧之參考，以提升臨床照顧品質。關鍵字：傷慟關懷服務、終止妊娠婦女、行動研究[[abstract]]Termination of pregnancy is not an issue to a case, a family or a hospital, it exists between you and me, an unbearable loss to a family, or even lead to strained relations and disputes between doctors and patients if it is not handled properly.Currently, he care abroad for termination abroad has reached comprehensively to a family-centered quality, and this issue has gradually been taken seriously in our country. The purpose of this study: To improve use the care process on women of pregnancy by bereavement services.The study was designed by participatory action research method, we invited a medical team (including a physician, nurse, psychologist, social worker, volunteer, funeral officers... etc.)from a delivery room of a medical center in Taoyuan.The study was designed based on Four stages：「define and statement of problem」,「looking for partners and developing of action strategies」,「execute improvement activities」,「valuation of the effectiveness」.Via the current investigation, we divided the caring issue into 3 category and made three action strategies: strategy I:「Concept internalization and skills advancement」,Strategy II:「tools enrichment」we have developed a numerous of forms of 「termination of pregnancy health education manual」, 「termination of pregnancy caring sheet」,「termination of pregnancy tracing sheet」 and fabrication relevant tools (fetus basket, fetal cloth, utility vehicles, and creation of the environment in labor room ),strategy III :「Upgrade quality of the caring process」.These concept of bereavement of caring provided the continuous and interdisciplinary service before and after hospitalization. It was found that sharing the practical experience might improve the motive for the nurse to care the termination woman of pregnancy. interdiscriplinary teamwork combine care might reduce the working pressure of nurse. Complete education before hospitalization help mother saying goodbye to fetus. The tools and forms promotes the amendments of the works. After application of these improved processes for taking care of termination women of pregnancy, many women felt appreciation for the nurses’ intimate behavior .During preparation of toys and clothes, she experienced being a mother, become of the motive of to do something for the children, her sadness and guilt can be relieved by the comprehensiveness care experience of sadness mission and obtained in spiritual comfort. The results of this study can be used as the reference for caring the termination women of pregnancy to improve the quality of clinical care.Keywords: bereavement service, termination woman of pregnancy, action research