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研究生:許怡雯
研究生(外文):I-wen Hsu
論文名稱:探討嬰兒使用安撫奶嘴與母乳哺餵狀況之關係
論文名稱(外文):The relationships between pacifiers used and breastfeeding of infants.
指導教授:張瑩如張瑩如引用關係
指導教授(外文):Ying-ju Chang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:護理學系碩博士班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
畢業學年度:96
語文別:中文
論文頁數:82
中文關鍵詞:安撫奶嘴母乳哺餵自信心母乳哺餵
外文關鍵詞:pacifiersthe breastfeeding self-efficacybreastfeeding
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世界衛生組織及國民健康局所提倡的成功哺餵母乳十步驟,其中步驟九提到「哺餵母乳之嬰兒,不給予人工乳頭或安撫奶嘴」,以免造成新生兒「乳頭混淆」。但是,吸吮安撫奶嘴是否真的會影響嬰兒建立正確的吸吮模式,而導致母乳哺餵失敗或提早中斷母乳哺餵期,目前仍然沒有定論。故本研究目的是在探討嬰兒使用安撫奶嘴的情形與母乳哺餵之關係以及在控制母乳哺餵自信心調節變項的影響後,嬰兒使用安撫奶嘴與母乳哺餵之關係。
本研究採縱貫式相關性研究設計,以結構式問卷調查161位台南市台灣籍育有正常足月新生兒之產婦,在住院期間、產後一個月、二個月及三個月其嬰兒使用安撫奶嘴的情形、哺餵狀況及母乳哺餵自信心。
研究結果發現,嬰兒有無使用安撫奶嘴與母乳哺餵有相關,有使用安撫奶嘴之嬰兒純母乳哺餵者比例較低;安撫奶嘴的使用頻率越高者者純完全母乳哺餵比例較低;安撫奶嘴的使用時間長短、使用類型與母乳哺餵的有顯著相關;第一次使用安撫奶嘴的時間則與母乳哺餵狀況無關;以邏輯斯迴歸控制母乳哺餵自信心之因素後發現,嬰兒使用安撫奶嘴與否、使用頻率、使用時間長度及使用類型並非純母乳哺餵與否之預測因子,母乳哺餵自信心才是重要因素。建議臨床對於嬰兒使用安撫奶嘴的政策可考慮更有彈性的使用,加強產婦之母乳哺餵自信心,才是促進母乳哺餵成功的關鍵。
Among the ten steps to successful breastfeeding advocated by the WHO, step nine clearly states that formula supplementation and pacifier use should be avoided to prevent nipple confusion. However, little evidences support the causal relationship between pacifiers used and breastfeeding. Purposes of this study were to explore (a) relationships between pacifiers used and breastfeeding of infants, and (b) whether these relationships were moderated by the factor of maternal breastfeeding self-efficacy.
One hundred and sixty-one healthy Taiwanese mothers and their full-term infants were studied. A structured questionnaire was used to obtain information of pacifiers used and breastfeeding. The Breastfeeding Self-Efficacy Scale (BSES) was used to measure maternal breastfeeding self-efficacy. Data was collected at periods of hospitalization, the first, second, and third months after discharge.
Results showed that pacifiers used of infants were significantly associated with breastfeeding. Lower exclusive breastfeeding rate was found in infants with pacifiers as compared to those without pacifiers. In infants who used pacifiers, the more often they used the lower exclusive breastfeeding rate. Duration and the type of pacifiers used were also significantly related to breastfeeding. There is no relationship between the first time that pacifiers used and breastfeeding. However, results of logistic regression analysis showed that after controlling for score of maternal BSES, whether a pacifier was used or not, frequency, duration, and types of pacifiers used were not predictors of exclusive breastfeeding rate. On the contrary, maternal breastfeeding efficacy was the significant predictor. Results of this study indicate that consideration of a flexible policy of pacifier used in infants is necessary. Strategies to enhance maternal breastfeeding efficacy are essential for successful breastfeeding .
中文摘要......................................................................................................................................Ⅰ
英文摘要......................................................................................................................................Ⅱ
誌謝..............................................................................................................................................Ⅳ
目錄..............................................................................................................................................Ⅴ
表目錄..........................................................................................................................................Ⅶ
圖目錄..........................................................................................................................................Ⅷ
第一章 緒論
第一節 研究動機與重要…………………………………………………………………1
第二節 研究問題…………………………………………………………………………4
第三節 研究目的…………………………………………………………………………5
第二章 文獻查證
第一節 嬰兒使用安撫奶嘴的利弊………………………………………………………6
第二節 乳頭混淆 (nipple confusion)的概念及形成機轉.................................................... 8
第三節 使用安撫奶嘴與母乳哺餵的關係..........................................................................10
第四節 嬰兒使用安撫奶嘴與母乳哺餵自信心之關係.....................................................17
第五節 研究概念架構圖.................................................... ...................................................19
第三章 研究設計
第一節 研究方法.................................................... ............................................................... 20
第二節 研究對象及地點.................................................... ...................................................20
第三節 研究工具.................................................... ............................................................... 21
第四節 資料收集過程.................................................... .......................................................25
第五節 資料分析.................................................... ............................................................... 26
第六節 倫理考量.................................................... ............................................................... 30
第四章 研究結果
第一節 研究對象基本資料之分析.................................................... ..................................31
第二節 嬰兒使用安撫奶嘴狀況.................................................... ......................................33
第三節 產後各階段母乳哺餵狀況及母乳哺餵自信心.....................................................38
第四節 嬰兒使用安撫奶嘴與母乳哺餵的關係.................................................... .............39
第五節 控制母乳哺餵自信心之後,嬰兒使用安撫奶嘴與母乳哺餵狀況關係之預測因子.................................................... ..............................................................................................50
第五章 討論
第一節 母乳哺餵狀況.................................................... ........................................................55
第二節 嬰兒使用安撫奶嘴狀況與母乳哺餵之關係.................................................... .....55
第三節 母乳哺餵自信心與嬰兒使用安撫奶嘴在預測純母乳哺餵之角色............. .....58
第六章 結論與建議
第一節 結論.................................................... ........................................................................61
第二節 護理上的應用與建議.................................................... ..........................................62
第三節 研究限制與未來研究方向.................................................... ..................................64
第七章 參考資料.................................................... ................................................................65
附件
附件一.................................................... .....................................................................................72
附件二.................................................... .....................................................................................73
附件三.................................................... .....................................................................................75
附件四.................................................... .....................................................................................76
附件五.................................................... .....................................................................................78
附件六.................................................... .....................................................................................80
附件七.................................................... .....................................................................................81
附件八.................................................... .....................................................................................82

表目錄
表2-1 嬰兒使用安撫奶嘴的相關研究整理比較………………………………………15
表3-1 研究工具內容效度鑑定值(CVI)…………………………………………….22
表3-5-1 資料的基本屬性……………………………………………………………….27
表3-5-2 統計分析……………………………………………………………………….28
表4-1 研究對象基本資料………………………………………………………………32
表4-2-1 母親使用安撫奶嘴意願調查表……………………………………………….33
表4-2-2 產後各時期嬰兒使用安撫奶嘴狀…………………………………………….36
表4-2-3 嬰兒第一次使用接觸安撫奶嘴的時間點及原因…………………………….37
表4-3 產後各時期母乳哺餵狀況及母乳哺餵自信心之調查…………………………38
表4-4-1 嬰兒有無使用安撫奶嘴與哺餵狀況關係…………………………………….40
表4-4-2 嬰兒使用安撫奶嘴的頻率與哺餵狀況關係………………………………….42
表4-4-3 嬰兒使用安撫奶嘴的時間長度與哺餵狀況關係…………………………….44
表4-4-4 嬰兒第一次使用安撫奶嘴的時間點與哺餵狀況關係……………………….46
表4-4-5 不同類型嬰兒安撫奶嘴的使用與哺餵狀況關係…………………………….48
表4-4-6 母乳哺餵自信心與母乳哺餵狀況關係……………………………………….49
表4-5-1 住院期間預測住院期間是否純母乳哺餵之邏輯斯迴歸預測模式………….51
表4-5-2 產後一個月預測產後一個月是否純母乳哺餵之邏輯斯迴歸預測模式…….52
表4-5-3 產後二個月預測產後二個月是否純母乳哺餵之邏輯斯迴歸預測模式…….53
表4-5-4 產後三個月預測產後三個月是否純母乳哺餵之邏輯斯迴歸預測模式…….54

圖目錄
圖一 研究概念架構圖…………………………………………………………………..19
圖二 收案流程圖………………………………………………………………………..25
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