出院準備對早產兒母親照護知識、能力及母育信心之成效

Effects of Discharge Planning on the Knowledge, Competence, and Maternal Confidence of the Mother with Preterm Infant

10.3966/102673012015092603002

林秀節(Shiow-Chieh Lin)；邱慧洳(Hui-Ju Chiu)；林寬佳(Kuan-Chia Lin)；許翠華(Tsui-Hua Hsu)；黃惠娟(Hui-Chuan Huang)

出院準備 ； 早產兒 ； 照護知識 ； 照護能力 ； 母育信心 ； discharge planning ； preterm infant ； care knowledge ； care ability ； maternal confidence

長庚護理

26卷3期（2015 / 09 / 01）

259 - 272

繁體中文

背景：早產兒於生理上較新生兒未成熟，早產兒母親需學習更多的照顧技巧；護理指導介入能提升母親與早產兒有更好的互動，目前國內有關之研究較少。因此，期望探討以社會認知理論內之自我效能為基礎之出院準備服務介入對早產兒母親照護知識、能力及信心之成效。方法：採前後測準實驗研究設計與方便取樣，收集四家區域醫院以上之新生兒中重度病房，對象為早產兒母親共63位，隨機分配至實驗組32位、對照組31位；實驗組接受病房的一般常規指導與出院準備，對照組只接受病房的一般常規指導。研究地點於早產兒轉至新生兒中重度病房進行前測，出院當日及返家一週進行後測1與後測2，而研究結果以廣義估計方程模式（Generalized Estimating Equations, GEE）進行統計分析。結果：研究結果顯示二組在照護知識、照護能力及母育信心於後測1並無顯著提昇（p ＞ .05），但於後測2，實驗組較對照組於照護知識、能力及母育信心均顯著提昇（p ＜ .05）；再經加入控制變項後，實驗組較對照組於後測1與後測2其在照護知識、照護能力及母育信心均顯著提昇（p ＜ .05）。結論：故以班杜拉（Albert Bandura）為基礎之出院準備介入，可提升早產兒母親照護能力，可作為醫院規畫早產兒照護課程之參考。

Background: Compared to full-term infants, preterm infants are physiologically immature. Thus, the mothers of preterm infants must acquire more caring skills than the mothers of full-term infants do. Implementing nursing interventions may improve the interactions between mothers and preterm infants. However, few local studies had been conducted before. The aim of this study was to evaluate the effect of discharge planning intervention on the caring knowledge, caring ability, and maternal confidence of mothers of preterm infants, based on the Self-efficacy of Social Cognitive Theory. Methods: The study was conducted with a pre- and post-test quasi-experimental design. Sixty-three mothers and their preterm infants admitted to the neonatal intermediate-to-intensive care units of four regional hospitals were recruited. The participants were randomly assigned to the experimental group (n=32) and control group (n=31). The participants in the experimental group received general instructions and discharge planning, while the participants in the control group only received general instructions. The pre-test was conducted when the preterm infants were transferred to the neonatal intermediateto- intensive care units, the post-test 1 was conducted on the day of discharge, and the post-test 2 was conducted one week after discharge. The test results were analyzed by generalized estimating equations. Results: The results indicated that overall, the participants in both groups did not improve considerably in their caring knowledge, caring ability, and maternal confidence at post-test 1. However, the participants in the experimental group showed considerable improvements in their caring knowledge, caring ability, and maternal confidence compared with those in the control group at post-test 2. When potential difference were controlled for, the participants in the experimental group exhibited considerable improvements in their caring knowledge, caring ability, and maternal confidence compared with those in the control group at post-test 1 and 2. Conclusion: Discharge planning based on Social Cognitive Theory proposed by Bandura may improve the caring ability of mothers of preterm infants and may be used as a reference for hospitals' preterm infant care programs.

1. Liaw, J.(2003).Use training program to enhance NICU nurses' cognitive abilities for assessing preterm infant behaviors and offering supportive interventions.Journal of Nursing Research,11(2),82-92.
   連結：
2. 郭淑芬、陳月枝、毛新春、鄒國英(2000)。個別性護理指導對初產婦新生兒照顧認知及母親自信度成效之探討。護理研究，8(2)，152-164。
   連結：
3. Ahmed, A. H.(2008).Breastfeeding preterm infants: An educational program to support mothers of preterm infants in Cairo, Egypt.Pediatric Nursing,34(2),125-138.
4. Aita, M.,Snider, L.(2003).The art of developmental care in the NICU: A concept analysis.Journal of Advanced Nursing,41(3),223-232.
5. Bandura, A.(1986).Social Foundations of Though and Action: A Social Cognitive.Englewood Cliffs, NJ:Prentice Hall.
6. Bandura, A.(1997).Self-efficacy: The efficacy of control.New York, NY:W. H. Freeman and Company.
7. Benzies, K.M.,Magill-Evans, J. E.,Hayden, K. A.,Ballantyne, M.(2013).Key components of early intervention programs for preterm infants and their parents: A systematic review and meta-analysis.BMC Pregnancy & Childbirth,13(1),1-15.
8. Bozzette, M.(2007).A review of research on premature infant-mother interaction.Newborn and Infant Nursing Reviews,7(1),49-55.
9. Broedsgaard, A.,Wagner, L.(2005).How to facilitate parents and their premature infant for the transition home.International Nursing Review,52,196-203.
10. Browne, J. V.,Talmi, A.(2005).Familybased intervention to enhance infant parent relationships in the neonatal intensive care unit.Journal of Pediatric Psychology,30(8),667-677.
11. Cuevas, K. D.,Silver, D. R.,Brooten, D.,Youngblut, J. M.,Bobo, C. M.(2005).The cost of prematurity: Hospital charges at birth and frequency of rehositalizations and Acute care visits over the first year of life: A comparison by gestational age and birth weight.American Journal of Nursing,105(7),56-64.
12. Damiani, G.,Federico, B.,Venditti, A.,Sicuro, L.,Rinaldi, S.,Cirio, F.,Pregno, C.,Riccizrdi, W.(2009).Hospital discharge planning and continuity of care for aged people in an Italian local health unit: Dose the care-home model redllce hospital readmission and mortality rates.BMC Health Services Research,9(22),1-9.
13. Erlandsson, K.,Fagerberg, I.(2005).Mothers' livd experiences of co-care and part-care after birth, and their strong desire to be close to their baby.Midwifery,21(2),131-138.
14. Evans, T.,Whittingham, K.,Boyd, R.(2012).What helps the mother of a preterm infant become securely attached, responsive, and well-adjusted?.Infant Behavior and Development,35,1-11.
15. Gaal, B. J.,Blatz, S.,Dix, J.,Jennings, B.(2008).Discharge planning utilizing the discharge train: Improved communication with families.Advances in Neonatal Care,8(1),42-55.
16. Goto, A.,Nguyen, T. V.,Pham, N. M.,Chung, T. T.,Trinh, H. P.,Yabe, J.,Sasaki, H.,Yasumura, S.(2010).Associations of psychosocial factors with maternal confidence among Japanese and Vietnamese mother.Journal of Child and Family Studies,19,118-127.
17. Heermann, J. A.,Wilson, M. E.,Wilhelm, P. A.(2005).Mothers in the NICU: Outsider to partner.Pediatric Nursing,31(3),176-200.
18. Howland, L. C.(2007).Preterm birth: Implications for family stress and coping.Newborn and Infant Nursing Reviews,7(1),14-19.
19. Johnson, A. N.(2008).Promoting maternal confidence in the ICU.Journal of Pediatric Health Care,22,254-257.
20. Kang, M.,Ragan, B. G.,Park, J. H.(2008).Issues in outcome research: An overview of randomization techniques for clinical trials.Journal of Athletic Training,43(2),215-221.
21. Kohlhoff, J.,Barnett, B.(2013).Parenting selfefficacy: Links with maternal depression, infant behaviour and adult attachment.Early Human Development,89,249-256.
22. Latal-Hajnal, B.,Siebenthal, K.,Kovari, H.,Bucher, H. U.,Largo, R. H.(2003).Postnatal growth in VLBW infants: Significant association with neurodevelopmental outcome.The Journal of Pediatrics,143(2),163-170.
23. Liu, C.,Chao, Y.,Huang, C.,Wei, F.,Chien, L.(2010).Effectiveness of applying empowerment strategies when establishing a support group for parents of preterm infants.Journal of Clinical Nursing,19,1729-1737.
24. Mantha, S.,Davies, B.,Moyer, A.,Crowe, K.(2008).Providing responsive nursing care to new mother with high and low confidence.The American Journal of Maternal Child Nursing,33(5),307-314.
25. Pennell, C.,Wittingham, K.,Boyd, R.,Sanders, M.,Colditz, P.(2012).Prematurity and parental self-efficacy: The preterm parenting & self-efficacy checklist.Infant Behavior and Development,33,678-688.
26. Ravn, I. H.,Smith, L.,Smeby, N. A.,Kynoe, N. M.,Sandvik, L.,Bunch, E. H.,Lindemann, R.(2012).Effects of early mother-infant intervention on outcomes in mothers and moderately and late preterm infants at age 1 year: A randomized controlled trial.Infant Behavior and Development,35,36-47.
27. Sanders, M. R.,Woolley, M. I.(2005).The relationship between maternal self-efficacy and parenting practices: implications for parent training.Child: Care, Health & Development,31,65-73.
28. Schroeder, M.,Pridham, K.(2006).Development of relationship competencies through guided participation for mothers of preterm Infants.Journal of Obstetric, Gynecologic, and Neonatal Nursing,35(3),358-368.
29. Shieh, S. J.,Chen, H. L.,Liu, F. C.,Lin, Y. H.,Tseng, H.,Wang, R. H.(2010).The effectiveness of structured discharge education on maternal confidence, caring knowledge and growth of premature newborns.Journal of Clinical Nursing,19,3307-3313.
30. Terry, G.,Marie, A.(2006).Transition to home from the newborn intensive care unit: Applying the principles of family-centered care to the discharge process.Journal of Perinatal & Neonatal Nursing,20(3),243-249.
31. Warren, P. L.(2005).First-time mothers: Social support and confidence in infant care.Journal of Advanced Nursing,50(5),479 -488.
32. Whittaker, K. A.,Cowley, S.(2012).A survey of parental self-efficacy experiences: maximizing potential through health visiting and universal parenting support.Journal of Clinical Nursing,21,3276-3286.
33. Zahr, L. K.(2000).Home-based intervention after discharge for Latino Families of low-birth weight infants.Infant Mental Health Journal,21(6),448-463.
34. Zeager, S. L.,Liang, K. Y.,Albert, P. S.(1988).Models for longitudinal data: a generalized estimating equation approach.Biometrics,44,1049-1060.
35. 郭于玲、邱艷芬(2007)。早產兒臥位對氧合及血液動力學的影響。榮總護理，24(1)，18-29。
36. 陳淑銘、楊惠美、莊惠如、周美玲(2005)。早產兒母親對早產兒的照顧需求及其影響因素。幼兒保育研究集刊，1(1)，30-41。
37. 葉娜琪(2005)。台北市=Taipei City, Taiwan, ROC.，國防大學系所=National Defense University。
38. 劉千琪、陳月枝(2011)。母育信心之概念分析。長庚護理，22(4)，472-478。

1. 陳莉貞,李紋帝,呂佩珍(2020)。照護一位新移民女性妊娠後期併發急性妊娠脂肪肝之加護經驗。長庚護理，31(1)，112-122。
2. 黃惠娟,林寬佳(2015)。護理追蹤性研究之統計分析模式發展。源遠護理，9(4)，12-23。
3. 賴美玲、蔡雅婷、柯雅芳(2017)。一位未足月婦女行剖腹產併發髂骨炎之照護經驗。助產雜誌，59，58-67。
4. 葉玲亞,陳昭蓉(2020)。照護一位重度聽障初產婦之護理經驗。助產雜誌，61，32-39。
5. 張淑瑛,江迎星(2020).協助一位早產兒母親建立親子依附關係之護理經驗.彰化護理,27(4),36-47.
6. (2023)。一位早產兒視網膜病變之護理經驗。長庚護理，34(增訂刊2)，1-11。