臺灣博碩士論文加值系統

背景：研究證實提供低出生體重新生兒袋鼠護理能穩定低出生體重新生兒的生命徵象；降低低體溫、感染的機率及因接受醫療處置的疼痛；提升生長指標上升速率及母親母乳哺育率。然而，醫療團隊在臨床推動袋鼠護理的過程中，因其單位背景、可運用的資源及需求的不同，會面臨獨特的障礙。「實證轉譯」則在考量了現有的最佳和最新的證據、臨床專業知識和評估及病人的喜好下幫助醫護人員及病人減少理論及臨床實踐中的差距。因此，如何於臨床建立一個具有實證基礎且能有效且落實推動袋鼠護理是重要的。本研究以實證為基礎，建立適用於研究場所中低出生體重新生兒執行袋鼠護理之『袋鼠護理標準照護模式』並進行臨床推動與評值。
方法：本研究為實驗性研究設計。於台灣北部某醫學中心新生兒加護病房進行。資料收集內容包含了護理人員實證遵從問卷、母親問卷(母育信心問卷、母嬰依附量表)，低體重新生兒生理資料，及袋鼠護理標準照護模式滿意度調查問卷。過程中，運用JBI-PACES實證轉譯技巧和研究實踐(GRiP)審查及回饋工具。研究共分為兩步驟進行：首先，成立袋鼠護理指引發展小組，先瞭解單位護理人員對於袋鼠護理的認知及態度並針對指引推動的阻、動力，整合實證知識，發展出『袋鼠護理標準照護模式』。第二步，將指引內容落於臨床實務，低出生體重新生兒及其母親被隨機分為實驗組及對照組兩組，對照組低出生體重新生兒及其母親接受病房中常規照護；實驗組低出生體重新生兒及其母親接受袋鼠護理標準照護模式照護內容並且追蹤低出生體重新生兒的住院天數、成長指標及母親的母育信心量表分數、母嬰依附量表分數。
結果：本研究共62組低出生體重新生兒及其母親(實驗組及對照組各31組)完成本研究。將資料分析統計後顯示袋鼠護理標準照護模式介入後實驗組低出生體重新生兒的住院天數較對照組少，但未達顯著差異外(20.06 ± 18.29天 vs 21.32 ± 3.84天, p = .80)；生長指標：體重(3168.23 ± 289.33公克 vs 3000.32 ± 197.54 公克, p = .01)、身長(49.58 ± 1.61公分 vs 48.79 ± 1.50公分, p = .05)、頭圍(34.84 ± 0.62公分 vs 34.11 ±1.15公分, p = .00)、母親母育信心量表(53.39 ± 5.63分 vs 46.26 ± 5.07, p = .00)、母嬰依附量表(82.87 ± 4.92分 vs 79.03 ± 5.75分, p = .01)分數均顯著高於對照組。
討論：此研究成果及實證轉譯技巧可用於臨床實務當中，以嘉惠許多的低出生體重新生兒及其母親。且如實證研究發現，袋鼠護理標準照護可以有效增加低出生體重新生兒成長指標、母親母育信心及母嬰依附關係。

Background: Studies have proved that providing kangaroo care for low-birth-weight infants can stabilize vital signs, reduce low body temperature, infection rate and pain due to medical treatment, as well as increase the rate of growth indicators and breast-feeding rate of mothers. However, health care providers face unique barriers to implementing KMC because of differences in context, available resources, and the needs identified during the initial situational analysis. “Evidence Translation” helps health care providers and patients reduce the gap between theory and clinical practice, taking into account existing best and up-to-date evidence, clinical expertise and assessment, and patient preferences. Therefore, it is important to establish an evidence basis and be effective in implementing kangaroo care. Based on empirical research, this study established a Kangaroo Nursing Standard Care Model suitable for low-birth-weight infants in research sites to carry out kangaroo care and conduct clinical promotion and evaluation.
Methods: This study was a experimental design which conducted in a neonatal intensive care unit of a medical center in northern Taiwan. The data collected included a questionnaire for nurses, a questionnaire for mothers and a questionnaire for satisfaction with Kangaroo Nursing Standard Care Model. Evidence translation of JBI-PACES and GRiP review along with feedback tools were used in the process. The study was divided into two steps. First, a kangaroo nursing guidelines development group was established to understand the perception and attitude of nursing staff towards kangaroo care, and to integrate empirical knowledge to develop a Kangaroo Nursing Standard Care Model. Second, put the guidelines into clinical practice. Low-birth-weight infants and their mothers were randomly divided into experimental group and control group. The control group of low-birth-weight infants and their mothers received routine care in the ward. In the experimental group, low-birth-weight infants and their mothers received the care as stipulated in Kangaroo Nursing Standard Care Model. The hospitalization days, growth indicators of infants, mother’s scores according to Mother Confidence Scale and scores according to Mother-infant Attachment Scale of low birth weight infants were tracked.
Results: A total of 62 groups of low-birth -weight newborns and their mothers (31 groups in the experimental group and 31 groups in the control group) completed the study. Data analysis showed that the number of hospitalization days of low-birth-weight infants in the experimental group was less than that in the control group after intervention of the Kangaroo Nursing Standard Care Model. But, there was no significant difference (20.06 ±18.29 days vs 21.32 ± 3.84 days, p = .80); Growth indicators: body weight (3168.23 ± 289.33 g vs 3000.32 ± 197.54 g, p = .01), body length (49.58 ± 1.61 cm vs 48.79 ± 1.50 cm, p = .05), head circumference (34.84 ± 0.62 cm vs 34.11 ± 1.15 cm, p = .00), Mother Confidence score(53.39 ± 5.63 cm vs 46.26 ± 5.07, p = .00), Mother-infant Attachment Scale scores (82.87 ± 4.92 scores vs 79.03 ± 5.75 scores, p = .01). The scores were significantly higher than those of control group.
Conclusions: The research results and evidence translation techniques could be used in clinical practice to benefit many low-birth-weight infants and their mothers. It was found that Kangaroo Nursing Standard Care Model could effectively increase the growth indicators of low-birth-weight infants, mother-rearing confidence score and mother-child attachment score.

誌謝 i
中文摘要 ii
英文摘要 iv
目錄 vii
圖目錄 x
目錄 xi
第壹章 緒論 1
第一節 研究動機及重要性 1
第二節 研究目的 3
第三節 研究問題 4
第四節 名詞界定 5
第貳章 文獻查證 7
第一節 實證的轉譯基本概念和應用 7
第二節 低出生體重新生兒簡介 12
第三節 袋鼠護理簡介 15
第四節 母育信心 19
第五節 母嬰依附關係 22
第參章 研究方法 27
第一節 概念架構 27
第二節 研究過程 28
第三節 研究對象與場所 38
第四節 低出生體重新生兒袋鼠護理標準照護模式 40
第五節 研究工具 44
第六節 資料統計與分析 47
第七節倫理考量 48
第肆章 研究結果 49
第一節 研究對象之基本資料分析 49
第二節 兩組低出生體重新生兒住院天數之比較 54
第三節 兩組低出生體重新生兒於出院後一個月生長指標之比較 56
第四節 兩組母親母育信心、母嬰依附關係量表分數之比較 58
第伍章 討論 64
第一節 分析人口學基本資料 64
第二節 袋鼠護理標準照護模式之成效 65
第陸章 結論 72
第一節 袋鼠護理標準照護模式之成效 72
第二節 護理應用 74
第三節 研究限制 77
參考文獻 78
中文文獻 78
英文文獻 79
附錄 91
附錄一、人體試驗計畫同意函 91
附錄二、2017年 JBI低出生體重新生兒執行袋鼠護最佳臨床建議 92
附件三、護理人員課前(後)問卷 97
附件四、低出生體重新生兒母親母育信心、母嬰依附關係問卷 98
附件五、袋鼠護理標準照護模式滿意度調查問卷 101
附件六、母育信心量表授權同意書 102
附件七、母嬰依附量表授權同意書 103

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