[[alternative]]Fathers’parenting role and influencing factors in fathers of preterm infants during hospitalization

[[abstract]]研究背景及目的：雖然寶寶的誕生是一件開心的事， 然而並非所有的寶寶皆能在足月的情況下出生，在沒有準備下接受孩子的出生，有父親在加護病房中覺得自己是個局外人，也對於不清楚自己的角色定位感到無所適從，加上母親產後需休息、做月子等習俗，父親必須在家庭、職場及醫院來回奔波，扮演多重角色。本研究欲了解早產兒父親在寶寶住加護病房在這段時間，面對突如其來的壓力事件是如何採取因應策略與父職能力之相關性，並分析影響父職能力之相關因素。研究方法：本研究採用橫斷性研究設計，以北部某三家醫學中心新生兒加護病房之早產兒父親為研究對象，在早產兒住院期間內採用結構式問卷進行資料收集。於2016年10月至2017年1月進行收案，以方便取樣方式，共發出60份問卷，有效樣本數為51位，回收率達85%。研究工具：本研究透過醫護人員轉介及早產兒父親自述，以結構式問卷收集早產兒基本資料、早產兒父親基本資料、新生兒加護病房壓力源量表(PCC,NICU) 、因應策略量表與父職角色量表，所得的資料經整理編碼後，使用SPSS 22.0 for Windows進行統計資料分析。研究成果：本研究顯示在社會支持部分，早產兒父親其對於社會支持系統仍有中等程度以上之需求。在住院壓力源部分，父親對於探訪時看到寶寶外觀和行為及寶寶接受的治療所感受到的壓力較大。“母親有孕產史或疾病史”之早產兒父親所使用之因應行為策略較多，在《以情緒取向之家屬因應》部分之行為策略情形較為顯著。藉由逐步迴歸分析，以情緒取向之因應策略為父職能力方程式之預測因子，且統計圖表發現早產兒住院天數越長之父親，以情緒取向之因應策略與父職能力雖為正相關，但R2解釋力逐漸下降。初為人父者之父職能力與“以情緒取向之家屬因應行為”分數相對較低。30歲以上之父親在“情緒取向之因應行為策略使用多者，自覺父親角色功能增加。討論及臨床應用：針對父職能力得分低者，希望未來護理人員能了解早產兒父親在早產兒住院期間所接收的父職壓力，進一步多關懷父親、慢慢教導父親學習如何觀察其生命徵象，可隨時評估早產兒生長發育狀況，並和醫護人員討論，降低其擔憂，並協助父親了解如何接觸、撫摸及照顧早產兒，以增加父親對寶寶之瞭解程度；再者，也提醒護理人員對於不同住院天數之父親，須給予不同衛教方式，除了鼓勵父親表達內心想法、情緒支持，教導正向情緒因應外，在父親想要主動了解寶寶病況及未來寶寶會面臨到的問題等相關資訊，給予詳細說明及衛教注意事項，例如:給予寶寶在住院期間可能會需要執行之檢查項目，像是視網膜病變檢查目的及必要性、腦室內白質化影響與定期追蹤等，也對於父親及早產兒的進步給予鼓勵與支持，提升父親之信心，使其父職角色充能；透過不斷的與早產兒的互動，提升父子間的緊密連結，使其父職能力逐漸增加。關於醫護人員部分亦有必要加強，也許父親因為剛入院無法吸收太多資訊，未來可以增加相關疾病衛教的QR CODE等E化程式，方便家屬查詢，定期舉行相關在職教育訓練，以增加臨床工作者照護能力。[[abstract]]Background and Purposes:It is greatly joyful to see the birth of their babies. However, not every infant can be born at full term .Having premature infants , some fathers in NICU think himself not only like a outsider, but also feel sense of loss about what to do in fatherhood. At the same time, fathers need to care their wives which following the traditional Chinese culture“doing the month”.Therefore, fathers may play multiple roles among family, work and hospital.The purpose of this study is to explore the relationship among fathers’ stress coping strategies, support of relatives, friends and medical professionals and parenting ability as their preterm infants living in neonatal intensive care unit ,Methods:This study was a cross-sectional design with convenience sampling. Fathers of their preterm infants admitted to neonatal intensive care unit were recruited in three north Taiwan medical centers from October 2016 to January 2017. The data were collected by a structured- questionnaires. Sixty potential participants were approached. Of these, 51 were willing to participate, yielding to a response rate of 85%.Measurement:Via referrals and the statement of preterm infants’ fathers, the data were collected by structured questionnaires. The questionnaires include: (1) the demographic information of fathers and infants and social support of relatives, friends and medical professionals, (2) the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU), (3) Jalowiec Coping Scale (JCS), (4) Fathering Ability in the NICU (FA: NICU). SPSS 22.0 were used for data analysis.Results:Fathers have more than medium need in social support system; During the hospitalization of infants, paternal stress between infant behavior and appearance were scored more than others. When the mother had maternal history or disease history, the father of preterm infant used more coping strategies than others. Although “emotion-focused” coping strategy is still a predictor, the longer hospitalization of preterm infants had a significantly negative relationship with R-square value of fathering ability by stepwise regression analysis. As a new dad, fathering ability and “emotion-focused” coping strategy scoring were significantly worse than others. For men over 30, the more “emotion-focused” coping strategies they used, the better fathering ability scoring they get.Conclusions and applications in nursing:In view of the low father's ability of fatherhood during their infants’ hospitalization, hoping that nurses can find the stress of premature fathers. Taking more care, and teaching them gradually to learn how to observe infants’ vital signs. By discussing with health care providers, fathers could relieve their concerns, help them understand how to touch, take care for preterm infants and increase fathering ability. For fatherhood during their infants’ imparity hospitalization, health care providers should teach the way of health education differently. For example, as their infants were admitted to NICU, fathers cannot obtain more information, thus increasing the relevant disease health education impotently by QR CODE program for fathers in the future. For managers, taking place on-the-job education regularly is also suggested so as to increase care ability of clinical health care providers