Schmied Virginia, Cooke Margaret, Gutwein Rosalind, Steinlein Elizabeth, Homer Caroline
School of Nursing and Midwifery, University of Western Sydney, Building ER, Parramatta Campus, Penrith South DC 1797, Penrith, NSW, Australia.
J Clin Nurs. 2009 Jul;18(13):1850-61. doi: 10.1111/j.1365-2702.2008.02746.x.
This study aimed to design, implement and evaluate strategies to improve the quality and content of hospital-based postnatal care.
Following birth, women report physical health problems, difficulties with breastfeeding, a lack of parenting self-efficacy and there is high occurrence of postnatal distress and depression. Despite these significant needs, women are frequently dissatisfied with the advice and support they receive from hospital-based postnatal care.
A pre/post test design compared the effect of multifaceted strategies on perceptions of quality and content of postnatal care, knowledge and experience of postnatal problems, parenting self-efficacy and breastfeeding outcomes. The key strategy, 'one-to-one time', focused on providing women an uninterrupted period of time each day when a midwife would be available to discuss women's concerns about their health and that of their baby.
A convenience sample of 146 women at baseline and 148 women postintervention completed a postal self-report questionnaire between 2-4 weeks postpartum.
There were no significant differences between baseline and postintervention groups in perceived quality of care, breastfeeding outcomes and maternal self-efficacy. Women experiencing health issues, including insufficient milk supply, backache, abnormal bleeding and urinary incontinence, were more likely to report that they received good or excellent care and advice in the postintervention group. Strategies to increase rest appeared effective with women less likely to report excessive tiredness postintervention. The key strategy, 'one-to-one time' was not consistently implemented, 57% of women reported they received 10 minutes or less of uninterrupted time with a midwife and only 11% reported that they were provided with 20 minutes or more.
There is the potential for individualised care to impact on outcomes for women but established routines and institutional priorities are difficult to change.
Midwives require both skill development and time to be able to sensitively listen to women's needs in the hospital postnatal setting.
本研究旨在设计、实施并评估提高医院产后护理质量和内容的策略。
分娩后，女性会出现身体健康问题、母乳喂养困难、育儿自我效能感不足，且产后困扰和抑郁的发生率较高。尽管有这些重大需求，但女性对医院产后护理所提供的建议和支持常常不满意。
一项前后测试设计比较了多方面策略对产后护理质量和内容认知、产后问题知识与经验、育儿自我效能感及母乳喂养结果的影响。关键策略“一对一时间”，重点是每天为女性提供一段不间断的时间，届时会有一名助产士为其解答对自身及婴儿健康的担忧。
采用便利抽样法，146名女性在基线期、148名女性在干预后，于产后2至4周完成一份邮寄式自我报告问卷。
在护理质量认知、母乳喂养结果和产妇自我效能感方面，基线组和干预后组之间无显著差异。在干预后组中，出现健康问题（包括乳汁供应不足、背痛、异常出血和尿失禁）的女性更有可能报告她们得到了良好或优质的护理及建议。增加休息的策略似乎有效，干预后女性报告过度疲劳的可能性降低。关键策略“一对一时间”未得到持续实施，57%的女性报告她们与助产士不间断相处的时间为10分钟或更短，只有11%的女性报告她们获得了20分钟或更长时间。
个性化护理有可能影响女性的护理结果，但既定的常规流程和机构优先事项难以改变。
助产士需要技能提升和时间，以便能够在医院产后环境中敏锐地倾听女性的需求。
