系統性護理指導介入對初入兒科 加護病房病童母親壓力源之影響

Abstract

多項研究證實，初次入兒科加護病房對病童母親而言，不僅是一個高壓力的情境，且確實需要各方面的支持。有鑑於此，本研究先著手研擬一套系統性護理指導採多媒體互動式光碟學習系統為輔助教學（Multimedia Interactive Videodisc Learning system; MIVD learning system, 簡稱MIVD），於病童入兒科加護病房時針對母親實施之，進而探討其對初次入兒科加護病房病童母親壓力降低程度之影響。 本研究設計採取類實驗法（Quasi-experimental design）之前、後測量設計，於95年1月至95年5月藉由方便取樣，選取北部某醫學中心初次入兒童加護病房的病童母親為研究對象。時間區隔分組，各收集30位控制組和實驗組研究對象，分別接受常規性護理指導及系統性護理指導，並於護理指導前後進行壓力程度之測量。本研究之研究工具包括「系統性護理指導光碟」及「兒童加護病房病童母親壓力源量表」二部份。藉由一對一訪談病童母親及填寫問卷方式進行資料收集。 研究結果證實，系統性護理指導可以使母親的各項壓力程度降低，經統計比較分析如下： 「孩子的病情」（Z＝-6.87, P＜0.05）、「醫護人員的解釋說明」（Z＝-6.81, P＜0.05）、「對醫護人員的信任」（Z＝-6.77, P＜0.05）、「親職功能改變，參與孩子的照顧」（Z＝-6.77, P＜0.05）、「監視儀器」（Z＝-6.85, P＜0.05）、「侵入性治療」（Z＝-6.78, P＜0.05）各方面的壓力源程度顯著降低，達到壓力程度總分顯著下降。經推論統計分析發現，實驗組母親的各項壓力降低程度明顯大於控制組。 綜合以上結果，證明在臨床上實施系統性護理指導（多媒體互動式光碟學習系統），較能提供初入兒科加護病房病童母親的資訊，同時較常規性護理指導有效的降低母親的壓力程度。因此本研究建議落實系統性護理指導（多媒體互動式光碟學習系統）應可作為提升相關護理研究設計和臨床重症護理品質的參考。

Many prior studies have shown that the first-time admission of a child to Pediatric Intensive Care Unit (PICU) is indeed a stressful situation for the mothers, and they need supports from all resources. Therefore, this study was aimed to establish a systemic nursing care program that uses multimedia interactive videodisc learning system as the assisting educational tool. The nurses can provide this program when sick children first admitted to PICU as a tool to reduce the mothers， stresses. A nonequivalent control group pretest-posttest quasi-experimental design was applied in the study. Children admitted to a certain tertiary medical center in northem Taiwan were conveniently recruited during January to May 2006. Sixty patients were assigned into the control and experimental groups, which received regular nursing care or systematic nursing instruction, respectively. Mothers， stresses were measured before and after all nursing instructions. The study tools include two parts: A systemic nursing instruction videodisc, and the PICU Mothers Stressor Scale. Data were collected through in-person interviews and self-adminstered questionnaires of mothers. Results showed that differences of mothers， stress levels between mothers who participate in the experimental and control groups were found for children，s condition(Z＝-6.87, P＜0.05), medical explanation (Z＝-6.81, P＜0.05), trust in medical personnel(Z＝-6.77, P＜0.05), alteration of parenting roles and participation in childhood care(Z＝-6.77, P＜0.05), monitor alarms(Z＝-6.85, P＜0.05), invasive treatment(Z＝-6.78, P＜0.05) were further decreased significantly. Comparing both the mothers in the experimental group and control group, the reduction of mothers， stress levels is more prominent using systemic nursing instructions.(Z＝-6.74, P＜0.05) As summary, this study demonstrated that implementing systematic nursing instruction using multimedia interactive videodisc learning system in clinical practice provided more actual and clear information to mothers, and significantly decreased their stress levels. Therefore, Systematic nursing instructions are strongly recommended for enhancing nursing care in PICU, and provide a valuable tool to promote nursing reseach and clinical intensive care quality.