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研究生:吳小莉
研究生(外文):Wu, Hsiao Li
論文名稱:產後出院準備服務照護需求及評量模式之建立--德懷研究
論文名稱(外文):Establishment of the Model of Postpartum Discharge Planning Program -- Delphi technique
指導教授:陳彰惠陳彰惠引用關係
指導教授(外文):Chung-Hey Chen
學位類別:碩士
校院名稱:高雄醫學院
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:1998
畢業學年度:86
語文別:中文
論文頁數:185
中文關鍵詞:出院準備服務照護需求評量指標德懷研究
外文關鍵詞:Discharge PlanningThe need for careEvaluating indicatorsDelphi technique
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本研究採以德懷研究法 (Delphi technique) 設計問卷,完成全程德
懷研究有國內100 位產科專家:地區教學醫院以上之護理長 39 位、醫師
37 位及專科以上護理學校之護理教師 24 位。研究工具為三回合問卷,
目的在蒐集並整合專家對我國於 84 年 3月 1 日實施全民健保,生產採
定額給付下的 [產後出院準備服務照護需求及評量指標]建構一致性的共
識,本研究問題首先以開放式問卷,經內容分析及至第二、第三次以結構
式問卷進行專家對重要選項的排序及陳述圈選重要性的理由。 本研究
方法以各選項排序平均值及標準差、T分數及六種標準選項原則,其研究
結果為: (一) 20 項母親照護需求選出 8 項非常重要項目:[衛教子宮
復舊過程、指導評估子宮收縮及護理];[給予產後惡露的照護並且促使其
具備評估惡露的自我照顧能力];[提供會陰護理並指導傷口自我照護的技
巧];[監測產婦排尿、排便通暢情形並提供便秘痔瘡護理];[以諮詢、手
冊或討論,指導攝取適當均衡之產後營養,哺乳期飲食或退奶飲食、方法
];[示教產後運動並有相關訊息的認知,以促進身材及身體機能的恢復]
;[陪伴及指導哺餵母乳技巧;教導正確乳房護理];[協助餵奶期間常見
之乳房問題及護理;脹奶、退奶、乳頭破裂、疼痛、乳頭異常]。(二) 15
項新生兒照護需求選出 8項非常重要項目:[協助產婦及家屬 (尤其配偶)
認識嬰兒的健康狀況及行為線索進而能評估寶寶生理、心理的生長與發育
];[教導照護嬰兒常見問題之評估及處理];[衛教遵行嬰幼兒預防注射、
健康檢查、新生兒篩檢並追蹤報告及必要處理];[示教新生兒沐浴的技巧
並予以回覆示教];[學習臍帶護理;臍帶脫落及預防臍帶感染之處理];[
教導新生兒黃疸的觀察與照護並提醒黃疸警訊和就醫處理];[強調親子教
育的重要性;協助親子互動與關係的建立];[提供出院後產褥期家庭追蹤
或特殊個案的協助,提供可利用的相關療護資源]及 (三) 7 項評量指
標--個案及家屬方面,選出 4 項非常重要項目:[產婦出院前後自我照護
能力的評價及滿意情形];[產婦出院前後新生兒照護能力的評價及滿意情
形];[產婦 (及家屬) 對所提供出院準備服務內容的認知、接受程度及其
差異比較];[產婦 (及家屬) 對所提供出院準備服務內容的滿意度、實用
性看法及實際執行情形]。(四) 7 項評量指標--健康照護體系方面,選出
7 項非常重要項目:[產婦嬰兒之住院天數、是否再住院及罹病原因、發
生率、天數或求診次數、原因];[產婦回診產後檢查率及嬰兒健康檢查率
、預防接種率];[生產後產婦及新生兒的良好健康狀態];[生產服務滿意
程度與個案再回院生產的意願以及醫院生產數的提昇];[醫院提供追蹤服
務與個案運用諮詢情形及滿意度];[定期評核提供服務的醫護人員知識、
態度與行為];[良好行政效率;臨床路徑的監測及以家庭為中心之照護措
施]。非常重要選項乃是專家達成共識性的分析亦是德懷研究的精神。
本研究的結果有助於釐清我國產婦早期出院準備的照護需求,提供產後期
非常重要的照護內容及品質監控的指標以供學界及臨床實務工作者職前及
在職教育的指引及評價依據,得使產婦獲得應有的照護。 關鍵詞:出
院準備服務、照護需求、評量指標、德懷研究
Delphi technique was used in de signing questionnaire for
this study. Ofthe 100 obstetric experts who completed the
questionnaires of this study were39 cheif nurses from district
teaching hospitals or bigger hospitals, 37physicians and 24
nursing teachers of nursing colleges or universities.Three
rounds of questionnaires were used in the study to collect
andintegrate experts'' opinions concerning "the care needs for
preparatoryservice for discharge after delivery and its
evaluating indicators" into a consensus. The first
questionnaire used open-ended questions to define thecontent of
this study. The second and third questionnaires were
constructedby analyzing the answers of the first one, utilizing
the weighed selectionof experts and sorting them in accordance
with their importance, therationale of the answers had to be
stated. The study used the mean of the rank, its
standard deviation, T score and6 statistical criteria of the
selected items to define the following: (I) 8 important
items out of 20 care needs of mothers were selected,
they are: (1) Evaluation of uterine contraction and lochial
amount. (2) Determining patients'' self-care ability.
(3) Care for perineum and wound self-care instruction.
(4) Monitoring patients'' urine output, bowel
movement and care for hemorrhoid. (5) Balanced
puerperal nutrition instruction through consultation, pamphlet
and open discussion. (6) Instructing
postpartum exercise. (7) Breast- feeding
instruction and care for breast and nipple. (8) Breast-
feeding problem management. (II) 8 important items out
of 15 care need of the newborns were selected , they
are: (1) Educating mothers and the relatives (fathers in
particular) about their infants'' developmental milestones. (2)
Instructing mothers to identify and manage the problems
inrearing their infants. (3) Informing the mothers to
follow the infants'' vaccination schedule, infant health
examination, infant metabolism screen test and the
follow-ups. (4) Demonstrate newborn bathing skill.
(5) Umbilical cord care and infection prevention
instruction. (6) Identifying neonatal jaundice. (7)
Emphasizing early parent-child interaction and help
establish the relationship. (8) Assist puerperal
follow-ups and provide relevant health care resources.
(III) 4 important items out of 7 evaluating indicators regarding
the case and her family, they are: (1) The evaluation
and satisfaction of self-care ability before and after
discharge. (2) The evaluation and satisfaction of
infant-care ability before and after discharge. (3) The
recognition, acceptance and the comparison of the content
of preparatory service for discharge. (4) The satisfaction,
opinion and the practice of the mothers and their families to
preparatory service for discharge. (IV) 7
evaluating indicators regarding health care delivery system were
identified, they are: (1) Hospitalized days of mothers and
infants, readmission and the causes, the incidence
rate, length of stay or outpatient visit frequency
and the causes. (2) The rates of postpartum OPD check-
up, well baby check-up and infant vaccination. (3) The
health condition of the mothers and newborns. (4) The
satisfaction of baby-delivery service, the willingness to return
for next delivery and the increase of the number of delivery in
the hospital. (5) The availability of follow-up
service provided by the hospital, the utilization and
satisfaction of cases using consultation
service. (6) The periodical KAP evaluation of the
relevant health care personnel. (7) Efficient administration,
clinical pathway monitoring and family-centered nursing care.
So called important items are the consensus reached by
the experts participated in the study, which has
strictly abided the spirit of Delphi technique. The
result of this study can help clarify the mothers'' needs for
preparatory service before discharge from hospital, indicate
importantcontent of puerperal stage care and establish
indicators for service qualitymonitoring. It can also provide
scholars and clinical practitioners withvery useful guideline
for prior and in-service training programs. Ultimately, it can
help mothers obtain quality service they deserve. Keywords:
Discharge planning, The need for care, Evaluating indicators,
Delphi technique
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