極低體重與超低體重早產兒父母親職壓力及照顧需求決定因素之縱貫性研究

Abstract

研究背景：極低體重及超低體重早產兒是罹病率最高、合併症最多且最脆弱的一群新生命，隨著生殖及醫療科技進步，台灣近年來造成較高死亡率與罹病率的出生體重小於1500公克之早產兒，約佔新生兒活產人數的1.82％-1.94％。他們的誕生往往帶給父母親龐大的壓力，父母親害怕自己沒有辦法好好照顧他們，也害怕無法兼顧維持家庭運作。然而，國內外少有文獻針對極低體重及超低體重早產兒族群討論父母親職壓力及照顧需求進行探討。 研究目的：本研究的目的探討1.極低體重及超低體重早產兒父母親職壓力及照顧需求於時間序上之變化、2.分析影響親職壓力與照顧需求之因素及3.探究早產兒父母親職壓力及照顧需求間之關係。 研究方法：本研究以縱貫性、描述性相關性研究進行，採立意取樣法，收案對象包括極低體重及超低體重早產兒及早產兒父母，以自填式結構式問卷配合病歷回溯進行資料收集，研究工具包括：自擬之早產兒基本資料表及父母親基本資料表、健康狀況自我評量尺度(EQ-5D VAS)、親職壓力量表簡式版、早產兒照顧需求量表、家屬需求量表及社會支持量表。於北部某醫學中心新生兒加護病房及新生兒中重度病房進行收案。每位早產兒父母各收案三次，分別於轉入新生兒病房後第 一天進行第一次收案，出院前一天進行第二次收案，並於出院後一個月完成第三次收案。以統計套裝軟體The Statistical Package for the Social Sciences第22版 (SPSS 22.0)進行資料分析。以描述性統計呈現父母親親職壓力及父母親照顧需求；以獨立樣本t檢定、單因子變異數分析、皮爾森積差相關係數及Kruskal-Wallis test、Mann-Whitney U test、逐步迴歸分析等推論性統計方法，檢測早產兒父母親親職壓力及照顧需求之相關及預測因子。 研究結果：本研究共納入30位早產兒及其父母親進行分析統計，結果發現，極低體重與超低體重早產兒父母親之居家照顧需求及家屬需求隨時間及病童返家後一個月逐漸降低，然而，極低體重與超低體重早產兒父母親親職壓力則呈不同的變化趨勢，母親的親職壓力於病童出院前最低，且早產兒母親親職壓力於病童出院後一個月來到最高，與轉入新生兒病房時相比有顯著差異(p= 0.022)，然而，父親則於病童轉入新生兒病房時親職壓力最小，經時間變化後逐漸升高，於病童出院後一個月達到最高，與轉入新生兒病房時相比有顯著差異(p= 0.026)。影響父母親照顧需求與親職壓力最主要的決定因素為前次需求或壓力。除此之外，不同時間點母親的早產兒居家照顧需求也受家庭型態、父親早產居家照顧需求及父親社會支持所影響，整體模型解釋力介於18.1%至65.6%間；父親的早產兒居家照顧需求則也為病童出生第一分鐘Apgar Score、手術史及出院醫療器材使用所影響，整體模型解釋力介於40.2%至55.1%；母親需求還為自覺健康及社會支持所影響，整體模型解釋力介於20.5%至70.8%；父親需求則亦為自覺健康、母親需求、社會支持及前次早產居家照顧需求所影響，整體模型解釋力介於13.9%至58.4%；母親親職壓力也受病童治療項目及自覺健康所影響，整體模型解釋力介於42.1%至49.1%；父親親職壓力亦為病童住院天數、母親需求及社會支持所影響，整體模型解釋力介於50.3%至61.7%。 結論：極低體重及超低體重早產兒父母親於不同時間點有不同的照顧需求及親職壓力內容改變，父母間早產兒居家照顧需求及父母需求變化趨勢大致相同，但父親親職壓力隨時間而逐漸上升。然而，影響父母親需求及親職壓力的決定因素時，父母親雖有不同預測模型，但前次所測得之需求或壓力常為影響下一次需求或壓力之決定因素，因此，無論是轉入病房時的第一次評估，或是出院前的再次評估皆很重要，若已發現早產兒父母親有照顧上需求或壓力時，應轉介個管師尋求幫助，不僅如此，研究發現父親需求及壓力皆不亞於母親，所以，必須個別考慮及評估父母親，給予適切的協助幫助降低其需求及壓力。

Background: Very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants are higher morbidities, more complications, and most vulnerable ones. With advanced reproductive and medical technology, birth weight lower than 1500gm preterm infants, which with high mortality and morbidity, are about 1.82%-1.94% of live births of the newborn in Taiwan. However, their delivery often puts enormous pressure on their parents. Parents with preterm infants are afraid that they can’t take good care of their child, and they may not be able to maintain family operations. Nevertheless, there is little research focus on parental stress and care needs among parents with VLBW and ELBW preterm infants. Aim: This study aimed to explore 1. the changes in parental stress and care needs of parents of VLBW and ELBW preterm infants at different time points. 2. the determinants affecting parental stress and care needs. 3. the relationship between parental stress and care needs. Method: This descriptive-correlational study adopted a longitudinal research design using a purposive sampling method to recruit subjects in the Neonatal Intensive Care Unit (NICU) and Newborn center (NBC) of a northern medical center. Parents were assessed by a set of self-structured questionnaires, including EQ-5D VAS, Parenting Stress Index Short Form, Premature Home Care Needs Scale, Family Needs Assessment, and Social Support Questionnaire Short Form. Parents completed all the questionnaires three times, including the time their baby had been transferred from NICU to NBC, the time of their baby discharged from hospital, and one month after their baby discharged from hospital. All statistical data analyses were carried out using IBM® SPSS® version 22. We performed the Mann-Whitney U test, Kruskal-Wallis test, Spearman’s rho, and linear regression with stepwise methods to assess the determinants factors of parental stress and care needs among parents of VLBW and ELBW preterm infants. Results: A total of 30 premature infants and their parents were recruited in this study. The results showed that VLBW and ELBW preterm parents' home care needs and family needs gradually decreased over time. However, parental stress showed different trends. Mothers' stress was lowest when the baby discharged from the hospital. Mother's stress was highest at one month after the baby discharged from the hospital, which was significantly higher than the time of the baby was transferred to the neonatal ward (p= 0.022). Nevertheless, father had the lowest parental stress when the baby was transferred to NBC and gradually increased over time. Father’s stress reached the highest in one month after discharged and was significantly higher than the time of babies were transferred to NBC (p= 0.026). The most crucial determinant of parental care needs and parental stress was the needs or stress of the previous time point. In addition, mother’s home care needs for premature baby were also affected by family structure, father’s home care needs, and father’s social support, the stepwise multiple regression models explained 18.1 to 65.6 percent of the variance. Father’s home care needs were also affected by baby’s first minute Apgar Score, surgical history, and home medical equipment, which explained 40.2 to 55.1 percent of the variance. Furthermore, mother’s needs were also affected by self-rated health status and social support, which explained 20.5 to 70.8 percent of the variance. Father’s needs were also affected by self-rated health status, mother’s needs, social support and previous home care needs, which explained 13.9 to 58.4 percent of the variances. Moreover, mother’s parental stress were also affected by baby’s treatment and self-rated health status, which explained 42.1 to 49.1 percent of the variance. Father’s parental stress were also affected by the length of stay, mother’s needs and social support, which explained 50.3 to 61.7 percent of the variance. Conclusion: The parents of VLBW and ELBW had different care needs and parental stress in time series. The trends of premature home care needs and care needs between parents were similar, but the parental stress was slightly different. However, when determining the determinants of parental needs and stress, parents had different prediction models, and father’s needs and stress were no less than mothers. Therefore, in order to reduce their own demand and stress. It is recommended to consider and evaluate the parents individually and provide appropriate assistance.