Nurses' Beliefs and Values about Doing Cue-Based Care in an NICU in Taiwan

台灣某新生兒加護中心護理人員對以早産兒行爲暗示爲基礎照顧之信念與價值觀

廖珍娟(Jen-Jiuan Liaw)；陳淑月(Shu-Yueh Chen)；尹引弟(Ying-Ti Yin)

以行爲暗示爲基礎之照顧 ； 早産兒 ； 新生兒加護中心 ； 質性研究 ； 信念 ； cue-based care ； preterm infant ； NICU ； qualitative research ； belief

The Journal of Nursing Research

12卷4期（2004 / 12 / 01）

275 - 286

英文

雖然進步的醫療科技已提昇早産兒的存活率，但這些最精密的科技卻也對早産兒産生了一些問題，然而科學對這些高危險性的病人並不是萬靈丹。有愈來愈多的研究報導醫療照護措施往往會引起早産兒生理及行爲的窘迫現象。這些研究結果促使新生兒加護中心的照護實務産生改變，嚐試努力減低壓力、加強保護早産兒，以促進早産兒的穩定與發展。本研究使用質性研究的方法來了解護理人員在照顧早産兒加護中心的護士如何照顧這些不成熟的早産兒？護理人員對以行爲線索爲基礎的照顧之看法如何？及護理人員使用這種照顧方式的程度爲何？研究結果産生三個重要論點：(1)適時及有技巧的處理早産兒；(2)提供早産兒及其壓力高的家屬完整性的照顧；(3)良好護理照顧與滿足重症早産兒、家屬、醫生、單位及環境需求之間的關系。研究結果顯示：新生兒加護的照顧方式大部分仍是以臨床需求爲主，提供以行爲線索爲基礎的照顧仍然是有困難的。理由是因照顧者知識缺乏、工作協作性不足及缺少行政系統的支持。爲了要改善新生兒加護中心的照護品質及早産兒的發展結果，必須定期教育護理人員以行爲線索爲基礎的照顧，增進這整個醫療團隊的協作關系，減少非護理的工作量，重整新生兒加護中心的環境，以便提供以行爲線索爲基礎的理想照顧。

Although advances in medical technology have increased the survival rate of preterm infants, science is no cure-all for these high-risk patients. A growing number of studies report that caregiving interventions cause physiological and behavioral distress in such infants. The results have prompted changes in caregiving practices, attempting to reduce stress and strengthen protection for the infants, in order to promote their stability and development in the neonatal intensive care unit (NICU). This study uses qualitative research methods to grasp the richness and diversity of nurses’ beliefs and experience in the taking care of preterm infants. Ten groups of questions explore how NICU nurses take care of premature infants, nurses’ perspectives on cue-based care, and the extent to which NICU nurses practice cue-based care. The results generated three themes: (1) timely and skillful management of the preterm infants; (2) compassionate and holistic care for the infants and their highly stressed families; and (3) the relationship between good nursing care and meeting the needs of preterm infants, families, physicians, units, and the environment. It is apparent that the approach to care delivery in NICU practice is still clinical-based, and that there are some obstacles to the delivery of cue-based care. The reasons for this include lack of knowledge, incomplete collaboration with team members, and insufficient support from the administrative systems. To improve the quality of nursing care and preterm infant outcomes, it will be necessary to educate NICU nurses on cue-based care, to enhance collaboration among all team members, to reduce their non-nursing workload, and to re-design NICUs for optimal cue-based care.

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