Wongkham Jamras, Pradubwong Suteera, Chatvised Phanwadee, Ratanasiri Thawalwong
J Med Assoc Thai. 2016 Aug;99 Suppl 5:S51-7.
The abnormalities of cleft lip and palate (CLP) condition are the serious problems which always found in the northeastern region of Thailand. The treatment must be sustainably and continuously integrated by the interdisciplinary team, including registered nurses who take care of all nine organizations under the corporation among nurses who work at Tawanchai Cleft Center. Starting from the diagnosis of the fetus by the new technology along with medical knowledge which can diagnose the abnormalities since birth. The diagnosis of the fetus with CLP affects mental and health of mother, so the nurse who takes extended care of them needs to have the data in order to plan the integration treatment and prepare them to be ready of confronting to the crisis. Also, this is for the adaption of fetal abnormalities and the encouragement for their new baby. Hence, clinical evidence triggered for care of pregnant women with fetal CLP is really important.
To trigger the clinical evidence of pregnant women whom found the fetal CLP at antenatal care unit, Srinagarind Hospital.
This descriptive study of clinical evidence-triggers for care of pregnant women with fetal CLP is the part of the study in antenatal care clinic which was applied to use the clinical evidence-triggers of The Center for Advance Nursing Practice Model. After the considerations of human ethics, the four stimulators were examined as the followings: 1) the simulation of practice triggers which was studied by reviewing five patient medical records in order to know the general data and health condition; 2) reviewed related literature, 3) interviewed five pregnant women whom diagnosed with fetal CLP, 4) interviewed one responsible nurse with 15-20 minutes, and using open-ended questions to ask about the health problems of pregnant woman, also giving an advice. The data were collected during January-December 2015. The descriptive data were analyzed using percentage and the qualitative data were analyzed by content analyses.
A total of five pregnant women with fetal CLP were included in the study with the mean age of 32 years, and the second pregnancy was 80%. The clinical problems of pregnancy with fetal CLP included: 1) mental and health of pregnant women and families; 2) discouragement of being pregnant and taking care of their pregnancy; 3) fetal facial image; and 4) nurture of such fetus after birth. The results after the diagnosis of pregnancy with fetal CLP and receiving advice from physicians and nurses were found regarding medical records that they were advised from the physician and nurse towards the abnormalities and chromosome inspection, and given treatment after birth. According to the interviewing of the nurse, it was found that the pregnancy felt regret and denied the diagnostic results, and needed treatment information. Besides, according to the interviewing of the pregnancy, it was found that they wanted to discontinue the pregnancy, needed information, wanted to know about any abnormality. The literature review revealed that nurses were those who providing care, knowledge, and advice.
The clinical problems of pregnant women detected with fetal CLP included feelings of disappointment, sadness, and regret whether or not found other abnormalities and being stress in caring for pregnant and postpartum care. The best handling and treatment was to obtain care from the interdisciplinary team in order to help them and their families to face with the crisis, accept to the abnormality of the fetus and having alternatives, and select such the appropriate alternatives, including antepartum and postpartum care.
唇腭裂（CLP）畸形是泰国东北部地区常见的严重问题。治疗必须由跨学科团队持续且连贯地进行，其中包括在Tawanchai腭裂中心工作的注册护士，她们负责公司旗下所有九个组织。从利用新技术诊断胎儿开始，结合医学知识，从出生起就能诊断出这些畸形。胎儿唇腭裂的诊断会影响母亲的心理和健康，因此提供长期护理的护士需要掌握相关数据，以便规划综合治疗方案，并帮助她们做好应对危机的准备。此外，这也是为了让她们适应胎儿的异常情况，并鼓励她们迎接新生命。因此，引发针对胎儿唇腭裂孕妇护理的临床证据非常重要。
引发在诗里拉吉医院产前护理单元发现胎儿唇腭裂的孕妇的临床证据。
这项关于胎儿唇腭裂孕妇护理临床证据触发因素的描述性研究，是产前护理诊所研究的一部分，应用了高级护理实践模式中心的临床证据触发因素。在考虑人类伦理后，对以下四个刺激因素进行了研究：1）实践触发因素模拟，通过查阅五份患者病历以了解一般数据和健康状况；2）查阅相关文献；3）采访五名被诊断为胎儿唇腭裂的孕妇；4）采访一名责任护士15 - 20分钟，使用开放式问题询问孕妇的健康问题并提供建议。数据收集于2015年1月至12月。描述性数据采用百分比分析，定性数据采用内容分析法进行分析。
共有五名胎儿唇腭裂孕妇纳入研究，平均年龄32岁，第二次怀孕占80%。胎儿唇腭裂孕妇的临床问题包括：1）孕妇及其家庭的心理和健康；2）对怀孕和照顾胎儿的沮丧情绪；3）胎儿面部形象；4）胎儿出生后的养育。在诊断胎儿唇腭裂并接受医生和护士建议后，病历显示她们接受了医生和护士关于异常情况和染色体检查的建议，并在出生后接受了治疗。根据对护士的访谈，发现孕妇感到后悔并否认诊断结果，需要治疗信息。此外，根据对孕妇的访谈，发现她们想终止妊娠，需要信息，想了解任何异常情况。文献综述表明护士是提供护理、知识和建议的人。
检测出胎儿唇腭裂的孕妇的临床问题包括失望、悲伤和后悔的情绪，无论是否发现其他异常，以及在孕期护理和产后护理中感到压力。最佳的处理和治疗方法是获得跨学科团队的护理，以帮助她们及其家人面对危机，接受胎儿的异常情况并拥有多种选择，然后选择合适的方案，包括产前和产后护理。
