發展性照護之理論發展與研究趨勢

Theoretical Development and Research Trends in Developmental Care

10.6224/JN.62.5.89

王淯汶(Yu-Wen Wang)；張瑩如(Ying-Ju Chang)

發展性照護 ； 新生兒個別化發展性照護及評估方案 ； 早產兒 ； developmental care ； the newborn individualized developmental care and assessment program ； premature infants (NIDCAP)

護理雜誌

62卷5期（2015 / 10 / 01）

89 - 95

繁體中文

以統合理論為基礎之個別化發展性照護乃是以嬰兒腦部正常發育為目標，提供早產兒或急重症嬰兒一個支持、促進、引導其發展之環境。基於其重要性，發展性照護之策略及評估內容在臨床上已被廣泛應用，本文透過文獻回顧，探討2000－2013年發展性照護之理論應用與實證依據，提出未來早產兒或急重症嬰兒發展性照護研究之建議。結果顯示多數研究支持發展性照護對早產兒之體重成長、減少氧氣依賴、縮短其住院天數、與2歲內之神經發展成果等成效，然而，在2歲至學齡期之長期發展成效的研究結果並不一致，故須考量各研究介入措施種類、成效指標與測量工具的差異性。此外，發展性照護對臨床照護已有深切影響，這使得研究族群暴露在發展性照護環境等因素皆可能影響研究結果。新生兒照護領域專業人員應進一步思考實施發展性照護對於早產兒及其家庭之核心價值，未來仍需要更多研究驗證發展性照護單一措施與整體照護程序之成效，並檢測發展性照護於健康照護跨領域合作時之共同成效指標，以持續在臨床建構有效的發展性照護方案。

The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), based on the Synactive Theory, is applied to improve brain development in premature and illness infants within a supportive environment. The NIDCAP has been used widely in the clinical setting. The aim of this article was to systematically review research published between 2000 and 2013 that relates to the evidence and application of developmental care. Most studies support the effectiveness of developmental care in terms of facilitating the healthy growth of premature infants, reducing oxygen dependence, reducing hospitalization times, and improving neurodevelopmental outcomes at two years of age. However, research results related to the effects of developmental care on neurodevelopmental outcomes from 2 years old to school age are not consistent. The heterogeneity of interventions, outcome indicators, and measurements in studies may contribute to these mixed results. In addition, as developmental care has been applied for many years, the contamination of participants in the supportive environment should be considered. Based on current evidence, neonatal healthcare professionals must recognize the core value of developmental care in dealing with premature infants and their families. In order to provide effective interventions for infants, further research is needed to assess the comparative effects of the single intervention and the holistic approach in developmental care.

1. Als, H.(1986).A synactive model of neonatal behavioral organization: Framework for the assessment of neurobehavioral development in the premature infant and for support of infants and parents in the neonatal intensive care environment.Physical and Occupational Therapy in Pediatrics,6(3/4),3-53.
2. Als, H.(2011).Lamarck, Darwin and the science of NIDCAP: Epigenetics in the NICU.Developmental Observer,4(2),2-4.
3. Als, H.(1982).Toward a synactive theory of development: Promise for the assessment and support if infant individuality.Infant Mental Health Journal,3(4),229-243.
4. Altimier, L.,Phillips, R. M.(2013).The neonatal integrative developmental care model: Seven neuroprotective core measures for family-centered developmental care.Newborn and Infant Nursing Reviews,13(1),9-22.
5. Coughlin, M.,Gibbins, S.,Hoath, S.(2009).Core measures for developmentally supportive care in the neonatal intensive care units: Theory, precedence and practice.Journal of Advanced Nursing,65(10),2239-2248.
6. Gibbins, S.,Hoath, S.,Coughlin, M.,Gibbins, A.,Franck, L.(2008).The universe of developmental care: A new conceptual model for application in the neonatal intensive care unit.Advances in Neonatal Care,8(3),141-147.
7. Honda, N.,Ohgi, S.,Wada, N.,Loo, K. K.,Higashimoto, Y.,Fukuda, K.(2013).Effect of therapeutic touch on brain activation of preterm infants in response to sensory punctate stimulus: A near-infrared spectroscopybased study.Archives of Disease in Childhood- Fetal and Neonatal Edition,98(3),F244-F248.
8. Jacobs, S. E.,Sokol, J.,Ohlsson, A.(2002).The newborn individualized developmental care and assessment program is not supported by meta-analyses of the data.The Journal of Pediatrics,140(6),699-706.
9. Nightingale, F. (1860). Notes on nursing: What it is and what it is not. New York, NY: D. Appleton and Company.
10. Ohlsson, A.,Jacobs, S. E.(2013).NIDCAP: A systematic review and meta-analyses of randomized controlled trials.Pediatrics,131(3),e881-e893.
11. Smith, K., Buehler, D., Hedlund, R., Kosta, S., & Als, H. (2011). NIDCAP nursery certification program (NNCP): A guide to preparation, application and implementation of NIDCAP nursery certification. Retrieved from http://www.nidcap.org/pdf/NNCP-Guide-7Jul11.pdf
12. Spittle, A.,Orton, J.,Anderson, P.,Boyd, R.,Doyle, L. W.(2012).Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants.Cochrane Database of Systematic Reviews,12,CD005495.
13. Symington, A. J.,Pinelli, J.(2006).Developmental care for promoting development and preventing morbidity in preterm infants.Cochrane Database of Systematic Reviews,2,CD001814.
14. Symington, A.,Pinelli, J. M.(2002).Distilling the evidence on developmental care: A systematic review.Advances in Neonatal Care,2(4),198-221.
15. Vanderveen, J. A.,Bassler, D.,Robertson, C. M. T.,Kirpalani, H.(2009).Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: A meta-analysis.Journal of Perinatology,29(5),343-351.
16. Wallin, L.,Eriksson, M.(2009).Newborn individual development care and assessment program (NIDCAP): A systematic review of the literature.Worldviews On Evidence-Based Nursing,6(2),54-69.
17. 陳永娟, Y. C.,張和美, H. M.,陳昭惠, C. H.(2005)。新生兒個別化發展性照護之應用。榮總護理，22(2)，204-210。

1. 戴仲宜,劉淑芬(2017)。音樂介入對早產兒生理指標的影響：系統性文獻回顧與統合分析。新臺北護理期刊，19(2)，47-59。
2. 郭惠貞,許曉竹(2019)。運用發展性照護於一位高膽紅素血症新生兒接受換血治療之護理經驗。領導護理，20(4)，82-93。
3. 黃素枝,王翊如(2021)。照顧一位感染大腸桿菌併發腦膿瘍術後嬰兒之護理經驗。榮總護理，38(1)，93-99。
4. 王軫薇(2020)。照護一位沙門氏菌感染併發細菌性腦膜炎嬰兒之加護護理經驗。助產雜誌，61，50-59。
5. 翁敏雪、周弘傑(2016)。父母於早產兒住院期間的親職議題及護理。護理雜誌，63(6)，114-119。
6. 楊曉玲,范圭玲,邱暄予(2020)。運用FOCUS家庭介入措施於四度腦室出血早產兒及其家庭之照護經驗。護理雜誌，67(1)，106-112。