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研究生:李秋桂
研究生(外文):Chiu-Kuei Lee
論文名稱:建構新生兒入住加護病房期間產後母親的照護實踐性理論
論文名稱(外文):Practical Theory Of Postpartum Mother Care During Newborn In The Neonatal Intensive Care Unit
指導教授:黃宣宜黃宣宜引用關係
指導教授(外文):Xuan-Yi Huang
口試委員:魏秀靜高千惠孫凡軻梁昭鉉
口試委員(外文):Shiow-Jing WeiChien-Hui KaoFan-Ko SunJao-Shwann Liang
口試日期:2022-07-07
學位類別:博士
校院名稱:國立臺北護理健康大學
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:2022
畢業學年度:110
語文別:中文
論文頁數:201
中文關鍵詞:新生兒加護病房產後母親照護實踐性理論紮根理論
外文關鍵詞:NICUPostpartum MotherCareSubstantive TheoryGrounded Theory
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當母親產下一個早產兒或新生兒合併嚴重併發症時,需接受新生兒加護病房的照護治療,對母親及家庭而言會產生極大的焦慮和壓力。坐月子是中華傳統文化頗具特色的一環,臨床發現母親在其新生兒入住加護病房期間,無法像正常母親好好調養身體,除了面對個人身心變化、各種坐月子的規範與禁忌、新生兒病況的衝擊,以及新冠肺炎疫情訪客限制,對她們而言這段時間是非常難熬,因此,醫療團隊提供適當的照護策略降低其心理衝擊及協助執行母職角色,是非常重要的議題。
研究者基於專業背景和過往的質性研究經驗,於文獻查證後確立研究主題,依據Strauss and Corbin(1990)紮根理論法來建構實踐性理論,研究程序包括:資料收集,採立意抽樣符合條件的受訪者同意且簽屬同意書後,藉由半結構的訪談指引,進行一對一訪談,訪談的錄音檔轉成逐字稿進行分析;資料分析包括開放性譯碼、主軸譯碼和選擇性譯碼,透過持續比較分析,適當的時機介入理論性抽樣等過程的交替運用,直至理論飽和。進而建構「新生兒入住加護病房期間產後母親的照護實踐性理論」。
本研究共邀請25位參與者進行研究,其中包含13位新生兒入住加護病房的產後母親,2位新生兒入住加護病房產後母親的家人,以及新生兒加護病房醫療團隊之2位醫師、5位護理師及各1位的專科護理師、社工師、復健師。所建構完成的實踐性理論以「正向面對執行母職之歷程」為核心類組,連結「產後母親面臨問題」、「醫療照護策略」、「醫療照護成效」等三個理論性類組,而建構形成等同實踐性理論的概念架構,並命名為「新生兒入住加護病房期間產後母親的照護實踐性理論」
此理論作為醫療團隊在新生兒入住加護病房期間產後母親的照護依據,建議醫療團隊針對產後母親面臨問題:心理衝擊及無法執行母職角色,運用降低母親心理衝擊、持續性的照護及協助執行母職角色的照護策略,以達緩解母親心理衝擊及展現母職角色的照護成效。
關鍵字:新生兒加護病房、產後母親、照護、實踐性理論、紮根理論

Abstract
When a mother give birth to a premature baby or a newborn with multiple severe complications, an admission to the neonatal intensive care unit (NICU) is required for the baby’s care and treatment. For the mother and the family, this creates great anxiety and stress. YueZi also known as postpartum care, is part of traditional Chinese culture. Clinical studies discovered that mothers who have newborns in the NICU could not take care of their body the way a normal mother would. In addition to physical and mental changes in the postpartum period, challenges such as the rules and taboos of YueZi, the impact of the baby’s disease on the mother, and the limitation on visitors due to COVID-19 can make this period of time very difficult. Therefore, providing a care strategy to reduce the psychological impact sustained during this period and to support motherhood is an important topic for the medical team.
Based on a review of the literature, the researchers’ backgrounds, and past qualitative research experiences, we established our research topic. Based on the grounded theory proposed by Strauss and Corbin (1990), we structured a substantive theory. The research process included data collection and obtaining written consent from participants selected through purposive sampling who matched the criteria. Using a guided semi-structured interview, a one-on-one interview was carried out. The interview was recorded and transcribed for further analysis. Data analysis comprised of open coding, axial coding, and selective coding. Through the alternating use of constant comparative analysis and intervening with theoretical sampling at appropriate timing until theoretical saturation, we structured “a substantive theory to care for postpartum mothers with a newborn in the NICU.”
This study invited a total of 25 participants, including 13 postpartum mothers with a newborn in the NICU, 2 family members of the postpartum mother with a newborn in the NICU, as well as 2 physicians, 5 nurses, 1 nursing specialist, 1 social worker, and 1 rehabilitator from the NICU medical team. The structured substantive theory uses “the process to fulfil maternal responsibility with a positive attitude” as a core category and connects three other theory-based categories: “problems postpartum mother encountered”, “medical care strategy”, and “effectiveness of medical care”. This forms a conceptual structure equivalent to the substantive theory. We have thus named it: “the substantive theory to care for postpartum mothers with a newborn in the NICU.”
This theory serves as a guide for the medical team to care for postpartum mothers with newborns in the NICU. We recommend that the medical team attach great importance to the problems a postpartum mother may encounter, such as the psychological impacts sustained by these mothers during this period and their inability to fulfil their maternal responsibilities. By reducing the psychological impacts imposed on these mothers and implementing strategies to continuously care and support their role as a mother, reduction of psychological impact and effectiveness in promoting motherhood can be achieved.
Keywords: NICU, Postpartum Mother, Care, Substantive Theory, Grounded Theory






目  次

中文摘要 …………………………………………………………………………… 3
英文摘要 ……………………………………………………………………………. 5
第一章 緒論
第一節 研究背景、動機及重要性 ……………………………………………… 10
第二節 研究問題 ………………………………………………………………… 16
第三節 研究目的 ………………………………………………………………… 16
第二章 文獻探討
第一節 新生兒入住加護病房期間其母親面臨的壓力………………………….. 18
第二節 新生兒入住加護病房期間產後母親的心路歷程……………………… 20
第三節 新生兒入住加護病房期間產後母親需求……………………………… 23
第四節 醫療團隊角色及功能…………………………………………………… 26
第五節 以家庭為中心的照護理念……………………………………………… 28
第六節 護理理論及紮根理論…………………………………………………… 29
第三章 研究方法
第一節 研究設計 ………………………………………………………………… 41
第二節 名詞界定………………………………………………………………… 42
第三節 研究進行的程序………………………………………………………… 43
第四節 資料收集………………………………………………………………….. 44
第五節 資料分析………………………………………………………………….. 51
第六節 理論初稿………………………………………………………………… 62
第七節 研究嚴謹度………………………………………………………………. 63
第八節 倫理考量………………………………………………………………… 67
第四章 研究結果 72
第一節 「正向面對執行母職之歷程」:核心類組……………………………… 73
第二節 新生兒入住加護病房期間產後母親面臨的問題……………………… 75
第三節 醫療照護策略…………………………………………………………… 93
第四節 醫療照護成效…………………………………………………………… 118
第五章 討論
第一節 研究貢獻………………………………………………………………… 129
第二節 研究發現………………………………………………………………… 131
第三節 研究限制………………………………………………………………… 148
第六章 結論與建議
第一節 結論………………………………………………………………………. 149
第二節 臨床實務建議……………………………………………………………. 151
第三節 未來研究方向建議………………………………………………………. 153
第四節 研究者反思………………………………………………………………. 154
參考文獻
中文部分 …………………………………………………………………………. 157
英文部分 …………………………………………………………………………. 162
表次
表2-1 Glasserian與Straussian紮根理論差別………………………………… 39
表3-1 初步資料收集的半結構訪談指引……………………………………… 50
圖次
圖3-1 本研究之研究進行程序圖……………………………………………… 43
圖3-2 The induction and deduction process in the constant comparative method…….. 57
圖4-1 新生兒入住加護病房期間產後母親照護實踐性理論………………… 75
附錄
附錄一 文獻列表………………………………………………………………… 186
附錄二 參與者基本資料附表……………………………………………………. 192

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