第二产程自由体位分娩决策辅助工具的开发与应用研究

doi:10.3761/j.issn.0254-1769.2022.20.003

摘要/Abstract

摘要：

目的构建产妇分娩过程中第二产程自由体位分娩决策辅助工具,并探讨其在临床中的应用效果。方法基于渥太华决策支持框架,通过文献分析并结合前期研究结果形成决策辅助工具初稿;经2轮专家函询和邀请30名产妇进行半结构式访谈修订形成工具终版。2021年7月—10月,采用便利抽样法,选取北京市某三级甲等综合医院进行分娩的69名产妇为研究对象,采用随机数字表法随机分为试验组和对照组。试验组在常规护理宣教的基础上使用第二产程自由体位分娩决策辅助工具;对照组采用常规护理。比较两组干预前后自由体位知识问卷、决策困境量表、决策准备量表修订版和患者参与治疗决策问卷得分。结果第二产程自由体位分娩决策辅助工具包含7项一级指标和31项二级指标。干预后,试验组自由体位知识问卷得分为[4.50（3.75,5.50）]分,高于对照组的[1.50（0.75,5.50）]分;决策准备量表修订版得分为（79.27±15.34）分,高于对照组的（46.07±20.68）分;决策困境量表得分为（20.26±11.34）分,低于对照组的（42.50±20.66）分,差异均具有统计学意义（P<0.05）;试验组参与分娩体位决策的意愿与程度增加更明显。结论第二产程自由体位分娩决策辅助工具科学性和实用性良好,可帮助产妇了解不同分娩体位的利弊、减少决策冲突,有助于实现医患共享决策,提升产妇分娩体验。

关键词: 自由体位分娩, 决策辅助工具, 效果评价, 产科护理学

Abstract:

Objective To construct a decision-making assistant tool for free body position delivery in the second stage of labor,and to explore its clinical application effect. Methods Under the guidance of Ottawa Decision Support Framework Theory,the first draft of the decision aid tool is formed after searching and analyzing the literature and combining the basis of previous research. After 2 rounds of expert consultations and the semi-structured interview revision with 30 parturients,the final version of the tool was formed. 69 pregnant women who delivered in a tertiary A hospital in Beijing from July to October 2021 were selected as the research subjects. They were randomly divided into an experimental group and a control group. On the basis of routine nursing education,the experimental group used the free body position delivery decision-making tool,and the control group received the routine nursing. The scores of free body position delivery knowledge,decision-making dilemma,decision-making preparation and decision-making participation were compared between the 2 groups. Results The decision-making assistant tool for free body position delivery in the second stage of labor includes 7 first-level indicators and 31 second-level indicators. After the intervention,the score of free posture knowledge questionnaire in the experimental group was[4.50（3.75,5.50）],which was higher than[1.50（0.75,5.50）] in the control group. The score of decision preparation scale（79.27±15.34） in the experimental group was higher than（46.07±20.68） in the control group. The score of decision distress scale（20.26±11.34） was lower than（42.50±20.66） in the control group,with statistical significance（P<0.05）. The willingness and degree of pregnant women to participate in medical decision-making increased. Conclusion The decision aid tool is scientific and practical. The tool can help pregnant women understand the advantages and disadvantages of different delivery positions,clearly select their preferences,and reduce decision making conflicts. It is helpful to realize doctor-patient shared decision-making and improve the delivery experience of pregnant women.

Key words: Free Position Delivery, Decision Aid Tool, Effect Evaluation, Obstetric Nursing

齐芮宁, 程欢, 冯嘉蕾, 刘军, 林秀峰, 岳洁雅, 张波, 包艾荣, 常凯. 第二产程自由体位分娩决策辅助工具的开发与应用研究[J]. 中华护理杂志, 2022, 57(20): 2452-2458.

QI Ruining, CHENG Huan, FENG Jialei, LIU Jun, LIN Xiufeng, YUE Jieya, ZHANG Bo, BAO Airong, CHANG Kai. Development and application of a decision aid tool for free body position delivery in the second stage of labor[J]. Chinese Journal of Nursing, 2022, 57(20): 2452-2458.

图/表 2

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