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

[[abstract]]由於醫療科技的進步及新生兒加護病房設備更新，早產兒之存活率大大提升，然而，早產兒的照顧對母親而言是極大挑戰，所以早產兒母親需要護理人員提供相關衛教以增加母親的照護能力，因此，提供早產兒母親有關返家後居家照護相關知識與技能，是設計早產兒出院準備內容的重要議題。本研究採用橫斷研究之前後測實驗性設計(experimental design)，藉以瞭解母親照顧早產兒的照護知識、能力及母育信心之現況，及探討以Bandura社會認知理論為基礎的出院準備服務，對返家初期早產兒母親的照護知識、能力及母育信心之成效。本研究採方便取樣(convenience sampling)，收案場所為北部一家醫學中心、二家區域醫院及桃園一家區域醫院，以早產兒母親為收案對象，收案期間自民國98年8月01日至99年03月30日，期間共計8個月，本研究以隨機(randomize)方式將個案分派至實驗組32位與對照組31位，測量工具包括「早產兒及母親之基本資料」、「照護知識量表」、「照護能力量表」及「母育信心量表」。研究結果：人口學與產科學基本資料(出生週數、出生體重、住院天數、此胎胎次)在實驗組、對照組間達統計上顯著差異；在照護知識、照護能力及母育信心三個依變項之前測，以獨立樣本t檢定(t-test)進行檢定，僅在母育信心之前測資料在實驗組與對照組間有顯著差異；經由Repeated Measurement控制出生週數、出生體重、住院天數、此胎胎次干擾因子外，無論在實驗組或對照組照護知識平均分數於後測1(出院當日)及後測2(出院一週)均無統計上顯著差異；照護能力平均分數僅於實驗組後測1及後測2達統計上顯著差異；無論在實驗組或對照組母育信心平均分數於後測1及後測2均無統計上顯著差異。以GEE估計二組研究對象在照護知識、照護能力及母育信心於前測、後測1、後測2之差異，經由控制出生週數、出生體重、住院天數及此次胎次干擾因子後，照護知識於組別差異部份，實驗組平均得分均低於對照組但未具統計上顯著差異(p> .05)，於時間差異部份，實驗組與對照組後測1及後測2未具統計上顯著差異(p > .05)，經時間與組別交互作用，實驗組、對照組後測1及後測2均具統計上顯著差異( p .05)，於時間差異部份，實驗組與對照組僅於後測2具統計上顯著差異(p .05). With regards to time difference, the experimental groups and control groups did not show statistical significant difference (p > .05) after post-test 1 and post-test 2. After interactions with groups over time, the experimental groups and control groups showed statistical significant difference (p .05) and the experimental groups received lower average score than control groups. With regards to time difference, the experimental groups and control groups only showed statistical significant difference in post-test 2 (p< .05) and after interaction with groups over time, both the experimental groups and control groups showed statistical significant difference (p< .05) in post-test 1 and post-test 2. In sum of the study results, the discharge planning based on Bandura's social cognitive theory can familiarize mothers of premature children with basic care skills through cumulative time. They will eventually face and adapt the impact brought by premature children. Therefore, discharge planning in one service merits promotion and applications.Keywords: Discharge Planning, Early Returning Home, Premature Children, Social Cognitive Theory, Care Knowledge, Care Ability, Maternal Confidence