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研究生:方嬋娟
研究生(外文):Chan-Chuan Fang
論文名稱:探討臨床實施袋鼠式護理的情況及其影響因素
論文名稱(外文):Exploration of the Clinical Implementation of Kangaroo Care and Related Factors
指導教授:卓妙如卓妙如引用關係
指導教授(外文):Miao-Ju Chwo
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
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:2002
畢業學年度:90
語文別:中文
論文頁數:106
中文關鍵詞:袋鼠式護理早產兒母嬰護理
外文關鍵詞:kangaroo carepreterm infantmaternal-infant nursing
相關次數:
  • 被引用被引用:5
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摘要
本研究採觀察訪談法,實際觀察台北地區4所醫學中心、1所區域醫院之30位母親、35位早產兒的產房生產流程、護理常規,及其實施袋鼠式護理的情形,並訪談實施袋鼠式護理單位護理長、早產兒母親,且以問卷調查產兒科相關單位共181位護理人員對袋鼠式護理的認知,目的為暸解袋鼠式護理的實施情形及其可能的影響因素。
研究結果顯示:5所醫院僅新生兒加護中心實施早、中、晚期袋鼠式護理,並沒有在產房及恢復室實施產後立即或極早期袋鼠式護理,其實施的時機及條件通常為出生後數天到數個星期,早產兒通常已接受密集的治療及觀察,且生理徵象穩定,沒有心搏過緩、呼吸暫停的情形;而接受照光治療、有氣管內插管接受呼吸器治療的早產兒亦可實施袋鼠式護理,而袋鼠式護理實施的對象並不限定為母親,其他家庭成員亦可執行;各家醫院多以屏風來提供隱密的空間,並沒有專屬的袋鼠護理室;此外,5所醫院普遍缺乏訂定袋鼠式護理的執行標準,且護理人員對袋鼠式護理的認知仍有不足的情形。
影響臨床實施袋鼠式護理的因素包括:(1)早產兒的妊娠週數較小、出生體重較輕、住院天數較長及住院期間的病況較複雜者,較有機會實施袋鼠式護理;(2)國內普遍有坐月子的習俗,使得母親較少返院探視早產兒,且家中長輩較不願意讓母親外出,及家中有其他小孩要照顧,另外父母缺乏有關袋鼠式護理的知識,而護理人員亦未告知都會影響臨床袋鼠式護理的實施;(3)產兒科的單位設計及照護理念仍為母嬰分離的概念,以至於母嬰接觸及實施袋鼠式護理的機會減少;(4)各單位普遍缺乏執行袋鼠式護理的標準;(5)加護中心的護理人員工作量大,無法配合或協助母親執行袋鼠式護理;且護理人員的積極度不夠,不會主動提供此資訊給家屬,此外護理人員對袋鼠式護理的認識不足,造成執行上認知的差異,都會影響袋鼠式護理在臨床的實施情形。
本研究建議:應加強護理人員有關袋鼠式護理的教育,強調親子早期互動的重要性,並提供袋鼠式護理對母兒的好處之相關臨床實證研究結果;且詳定袋鼠式護理的執行標準,視袋鼠式護理為單位常規並製作相關衛教資料,以提高護理人員協助執行袋鼠式護理的積極度;另外母嬰護理應儘可能的結合,如提倡早產兒母嬰同室的措施,產科護理人員在產後應立即提供母兒有皮膚接觸皮膚的機會或提供父母袋鼠式護理的資訊,可解決母親坐月子或早產兒住院天數的限制,以促進母嬰的早期接觸,藉由提供此一人性化的護理,提昇母嬰的護理品質。
Abstract
The purposes of this study were to investigate the clinical implementation of kangaroo care (KC) and related factors. The data collection methods of this study were observation, interview, and questionnaires. Four medical centers and one regional hospital in Taipei were observed from the premature labor at delivery room to the implementation of KC at pediatric ward. The samples consisted of 30 mothers and 35 preterm infants. The head nurses of the KC implementation ward were interviewed. One hundred eighty-one nurses who work in the obstetric or pediatric wards answered the questionnaires.
The results indicate that five hospitals only provided the early, intermediate, and late KC at neonatal intensive care unit (NICU), the birth and very early KC were not available at delivery room or recovery room. The opportunities and criteria were preterm infants who have received the close treatment and observation, vital sings stable, no bradycardia or apnea events; preterm infants receiving phototherapy or intubated with assisted ventilation could participate in KC. Not only did mothers provide KC, but also family members, such as father or uncle. Five hospitals only provided privacy with screens for KC practice, no specific KC room was provided. No implemental standard for KC practice and the nurse’s knowledge about KC indication were deficit.
The related factors for KC practice in clinical settings were as follows: (1) the preterm infants who have more chance to received KC were the ones with smaller gestational age, lower birth weight, or longer length of stay; (2) mother was confined during the month after childbirth, another child was at home, and parents were lack of information of KC, which prevented mother from visiting her infant; (3) the ward design and nursing theme were the concept of maternal-infant separation which decreased the chance of parent-infant interaction and KC practice; (4) there were lack of implemental standard for KC practice; (5) compared to the nurses in the general ward, nurses had larger workload in the NICU and no time for KC assistance; besides, some nurses’ knowledge about KC were deficit, so they were not actively to supply KC information to parents.
From this study, we suggest that nurses need to be educated the knowledge of KC; for example, emphasize the value of KC to early parent-infant interaction, offer evidence-based nursing research of KC benefit to parents, define the policy and procedure standards for KC as routines, and develop the KC brochure for parents. In addition, maternal-infant nursing should be linked together, such as “rooming-in” for preterm infants. Therefore, obstetric nurses can provide the chance for skin-to-skin contact of mother and infant after birth, offer information of KC for parents to overcome the barriers of doing the month or length of stay, and improve the early contact of mother and infant.
正文目錄
第一章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 3
第四節 名詞解釋 5
第二章 文獻查證 6
第一節 早產兒的照護理念 6
第二節 袋鼠式護理的臨床應用 13
第三節 評價內容 19
第三章 研究方法 23
第一節 研究對象 23
第二節 研究工具 23
第三節 資料收集過程 25
第四節 資料分析方法 26
第四章 研究結果 28
第一節 研究對象之基本資料 28
第二節 醫院硬體結構、生產流程及袋鼠式護理實際觀察情形 38
第三節 護理長及早產兒母親訪談內容 53
第四節 護理人員對袋鼠式護理的認識 61
第五章 討論 68
第一節 研究對象之基本資料 68
第二節 醫院硬體結構、生產流程及袋鼠式護理實際觀察情形 70
第三節 護理長及早產兒母親訪談內容 77
第四節 護理人員對袋鼠式護理的認識 81
第六章 結論與建議 85
第一節 結論 85
第二節 護理上的應用 87
第三節 研究限制與建議 88
參考資料 90
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