超低出生体重儿精细化照护培训方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2021.02.003

摘要/Abstract

摘要：

目的构建、实施并评价超低出生体重儿精细化照护培训方案的有效性。方法构建超低出生体重儿精细化照护培训方案,包括课前预习、个体化发育支持护理评估程序、气道集束化照护技术、营养喂养技术、血管通路的建立和管理技术、家庭参与式照护技术。2019年3月对新生儿重症监护病房护士按超低出生体重儿精细化照护培训方案进行培训,应用柯氏评价模式评估培训效果。结果培训后97.0%的护士对精细化照护内容满意,94.1%的护士对教学形式满意,91.2%的护士对教学环境满意;100%的护士认为培训后改变了护理态度,增加了为超低出生体重儿提供更好护理的信心;培训前护士理论考核成绩为（59.7±13.6）分,培训后为（88.4±6.2）分,差异具有统计学意义（t=-14.763,P<0.001）;培训前后嗅觉、听觉、触觉等多感官的发育支持,疼痛管理,动脉、静脉置管规范,可视化穿刺,经外周中心静脉置管和维护、手法复位、原位换管,脐动脉、静脉维护,父母支持模式、袋鼠式护理得分差异具有统计学意义（均P<0.05）。结论构建的超低出生体重儿精细化照护培训方案可有效提高护理人员对超低出生体重儿的护理能力。

关键词: 精细化照护, 超低出生体重儿, 新生儿重症监护病房, 新生儿护理

Abstract:

Objective To construct,implement and evaluate the effectiveness of the refined nursing training programme for ultra-low birth weight infants. Methods A refined care training programme for ultra-low birth weight infants was constructed,including individualized development support,airway cluster care,nutritional feeding,establishment and management of vascular access,family participatory care,and selection and training of nursing staff in the neonatal intensive care unit. In March 2019,we implemented the training of refined care training programme for ultra-low birth weight infants,and applied the Korotkoff evaluation model to assess the training effects. Results After the training,97.0% of the nursing students were satisfied with the refined care content;94.1% of the nursing students were satisfied with the teaching methods; 91.2% of the nursing students were satisfied with the teaching environment;100% of the nursing students thought that their nursing attitudes had been changed after the training,and they believed that they had enhanced the nursing confidence of ultra-low birth weight infants. The theoretical assessment score of nursing students before the training was（59.7±13.6） points,and it was（88.4±6.2） points after the training with statistically significant differences（t=-14.763,P<0.001）. There were statistically significant differences in the development support such as smell,hearing and touch,pain control,arteriovenous catheterization,visual puncture,maintenance of peripheral central venous catheterization and manual reduction,in-situ tube replacement,umbilical arteriovenous maintenance,parental support model and kangaroo-style nursing technique before and after the training（P<0.05）. Conclusion The refined care training programme for ultra-low birth weight infants can effectively improve the nursing ability of nursing staff for ultra-low birth weight infants.

Key words: Refined Care, Ultra Low Birth Weight Infant, Neonatal Intensive Care Unit, Neonatal Nursing

唐云飞, 朱亭立, 胡晓静. 超低出生体重儿精细化照护培训方案的构建及应用研究[J]. 中华护理杂志, 2021, 56(2): 177-182.

TANG Yunfei, ZHU Tingli, HU Xiaojing. Construction and application of refined care training programme for ultra-low birth weight infants[J]. Chinese Journal of Nursing, 2021, 56(2): 177-182.

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参考文献 24

[1]	中国新生儿重症监护室协作性质量改进研究协作组. 极低和超低出生体重儿重度脑室内出血发生情况及其影响因素多中心研究[J]. 中华儿科杂志, 2019,57(4):258-264.
	Reduction of Infection in Chinese Neonatal Intensive Care Units Using the Evidence-based Practice for Improving Quality Study Group. Incidence and risk factors of severe intraventricular hemorrhage in very low and extremely low birth weight infants:a multi-center study[J]. Chin J Pediatr, 2019,57(4):258-264.
[2]	超未成熟儿与超低出生体重儿研究协作组. 超未成熟儿与超低出生体重儿住院并发症分析[J]. 中华儿科杂志, 2015,53(5):334-340.
	Collaborative Study Group for Extremely Preterm. The morbidities of extremely preterm and extremely low birth weight infants during hospitalization[J]. Chin J Pediatr, 2015,53(5):334-340.
[3]	Stoll BJ, Hansen NI, Bell EF , et al. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network[J]. Pediatrics, 2010,126(3):443-456.
[4]	Ishii N, Kono Y, Yonemoto N , et al. Outcomes of infants born at 22 and 23 weeks' gestation[J]. Pediatrics, 2013,132(1):62-71.
[5]	林丽, 黄继谦, 诸葛张明 , 等. 超低出生体重儿243例存活率和并发症临床分析[J]. 中华新生儿科杂志(中英文), 2017,32(4):259-263.
	Lin L, Huang JQ, Zhuge ZM , et al. Survival rates and complications among 243 cases of extremely low birth weight infants[J]. Chin J Neonatol, 2017,32(4):259-263.
[6]	周薇, 段志洲, 张杰 , 等. 妊娠期糖尿病对新生儿出生体重的影响[J]. 公共卫生与预防医学, 2017,28(6):52-55.
	Zhou W, Duan ZZ, Zhang J , et al. The impact of gestational diabetes mellitus on birth weight[J]. J Public Heal Prev Med, 2017,28(6):52-55.
[7]	Charsha DS . Gently caring:supporting the first few critical hours of life for the extremely low birth weight infant[J]. Crit Care Nurs Clin N Am, 2009,21(1):57-65.
[8]	Pediatrics AAO , Committee on Fetus and Newborn and Section on Surgery,Section on Anesthesiology and Pain Medicine, et al. Prevention and management of pain in the neonate:an update[J]. Pediatrics, 2006,118(5):2231-2241.
[9]	Ullrich M . Gentle care of the premature[J]. Kinderkrankenschwester, 1998,17(2):60-62.
[10]	张春丽, 蒋益群, 温景莲 . 精细化管理在新生儿床旁护理同质化服务中的应用效果[J]. 广州医科大学学报, 2018,46(2):116-118.
	Zhang CL, Jiang YQ, Wen JL . The application effect of refined management in the homogenization of bedside nursing care of newborn babies[J]. Acad J Guangzhou Med Univ, 2018,46(2):116-118.
[11]	Abdulghani HM, Shaik SA, Khamis N , et al. Research methodology workshops evaluation using the Kirkpatrick's model:translating theory into practice[J]. Med Teach, 2014,36(sup1):S24-S29.
[12]	唐纳德 L 柯克帕特里克, 詹姆斯 D 柯克帕特里克. 奚卫华,林祝君等译. 如何做好培训评估:柯氏四级评估法[M]. 北京: 机械工业出版社, 2007: 16-20.
	Donald L Kirkpatrick, James D Kirkpatrick. Xi WH, Lin ZJ, et al translated. Evaluating training programs[M]. Beijing: China Machine Press, 2007: 16-20.
[13]	连海燕, 孙琴琴 . 基于柯氏模型的手术室护理人员移动终端培训效果评价[J]. 护理实践与研究, 2019,16(1):125-127.
	Lian HY, Sun QQ . Evaluation training effect of mobile terminal for operating room nursing staff based on Kirkpatrick model[J]. Nurs Pract Res, 2019,16(1):125-127.
[14]	王雪, 朱平, 张淑燕 , 等. 柯式评估模型在康复治疗师培训效果评估中的应用[J]. 中国康复理论与实践, 2016,22(9):1114-1116.
	Wang X, Zhu P, Zhang SY , et al. Effects of therapist training:evaluated with kirkpatrick's model[J]. Chin J Rehabilitation Theory Pract, 2016,22(9):1114-1116.
[15]	邵雨娜, 孙慧敏, 李敏丽 , 等. NICU护理人员共情沟通课程的构建及实施效果评价[J]. 中华护理杂志, 2018,53(8):901-906.
	Shao YN, Sun HM, Li ML , et al. Construction and implementation of empathic communication course for NICU nurses[J]. Chin J Nurs, 2018,53(8):901-906.
[16]	凌陶, 金瑞华, 淮盼盼 . 护理模拟引导者培训课程的初步构建[J]. 中华护理杂志, 2020,55(3):433-439.
	Ling T, Jin RH, Huai PP . The preliminary construction of the training course for nursing simulation facilitators[J]. Chin J Nurs, 2020,55(3):433-439.
[17]	超未成熟儿与超低出生体重儿研究协作组. 广东省超未成熟儿与超低出生体重儿临床救治分析[J]. 中华儿科杂志, 2019,57(12):934-942.
	Research Collaborative Group of Ultra-immature and Extremely Low Birth Weight Infants. Short term outcomes and their related risk factors of extremely preterm and extremely low birth weight infants in Guangdong province[J]. Chin J Pediatr, 2019,57(12):934-942.
[18]	梁必会 . 以家庭为中心的护理对早产儿父母照护能力的影响研究[D]. 苏州:苏州大学, 2018.
	Liang BH . Study on the influence of family centered care on the care ability of preterm baby parents[D]. Suzhou:Soochow University, 2018.
[19]	赵晓红 . 延续性护理对早期早产儿生长发育和再住院率的影响[J]. 临床医学研究与实践, 2019,4(9):167-169.
	Zhao XH . Effects of continuous nursing on growth and development and re-hospitalization rate of early preterm infants[J]. Clin Res Pract, 2019,4(9):167-169.
[20]	郭敏, 王翠, 张楠 , 等. 袋鼠式护理对早产儿生长发育影响的系统评价[J]. 护理学报, 2018,25(16):27-33.
	Guo M, Wang C, Zhang N , et al. Systematic review of influence of kangaroo mother care on growth and development of premature infants[J]. J Nurs China, 2018,25(16):27-33.
[21]	胡晓静, 张玉侠, 庄薇 , 等. 新生儿重症监护病房早产儿袋鼠式照护的评估与实施[J]. 中国循证儿科杂志, 2019,14(1):64-68.
	Hu XJ, Zhang YX, Zhuang W , et al. Kangaroo care for premature infants in neonatal intensive care units[J]. Chin J Evid-Based Pediatr, 2019,14(1):64-68.
[22]	胡晓静, 张雪萍, 刘婵 , 等. 精细化照护策略对超低出生体质量儿短期结局的影响[J]. 中国实用护理杂志, 2017,33(20):1558-1562.
	Hu XJ, Zhang XP, Liu C , et al. Effect of gently caring on clinical outcomes of extremely low birth weight infants[J]. Chin J Pract Nurs, 2017,33(20):1558-1562.
[23]	王佳弘, 席文杰, 董丽丽 , 等. 虚拟仿真技术在护理教育中的应用与挑战[J]. 中华护理杂志, 2020,55(3):401-404.
	Wang JH, Xi WJ, Dong LL , et al. Challenges and countermeasures in the application of virtual reality technology in nursing education[J]. Chin J Nurs, 2020,55(3):401-404.
[24]	刘杰 . 精细化护理在新生儿重症监护病房中的应用效果[J]. 河南医学研究, 2019,28(19):3636-3637.
	Liu J . Application effect of refined nursing in neonatal intensive care unit[J]. Henan Med Res, 2019,28(19):3636-3637.