Toly Valerie Boebel, Sattar Abdus, Zauszniewski Jaclene A
Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Drs Toly and Zauszniewski); and Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio (Dr Sattar).
J Perinat Neonatal Nurs. 2019 Jul/Sep;33(3):268-275. doi: 10.1097/JPN.0000000000000428.
This study examined the relationship of mothers' psychological well-being (depressive symptoms, posttraumatic stress symptoms) and resourcefulness with their technology-dependent infants' healthcare utilization (rehospitalization, emergency department [ED] visits) following discharge from the neonatal intensive care unit (NICU). This descriptive, correlational study was conducted at a large Midwest level 4 NICU in the United States. Mothers (n = 19) with a technology-dependent infant (eg, supplemental oxygen, feeding tubes) to be discharged home from the NICU within 2 to 3 weeks were interviewed face-to-face using standardized instruments. Infant rehospitalization and ED visit data were collected from the electronic medical record (EMR) for the first 3 months following the infant's discharge. Analyses included descriptive statistics and negative binomial regression. A majority of infants (72.2%) required at least 1 hospitalization; 33% required at least one ED visit. Mothers' age and resourcefulness were significant predictors of ED visits while only resourcefulness predicted rehospitalizations. Neither depressive symptoms nor posttraumatic stress symptoms significantly predicted healthcare utilization. Maternal resourcefulness was the only main variable that significantly predicted both ED visits and hospitalizations and one of the few modifiable factors that could assist mothers with successfully coping with the complexity of caring for a technology-dependent infant. Future research should focus on interventions to enhance mothers' resourcefulness prior to their technology-dependent infant's NICU discharge.
本研究探讨了母亲的心理健康状况（抑郁症状、创伤后应激症状）和应变能力与她们在新生儿重症监护病房（NICU）出院后技术依赖型婴儿的医疗保健利用情况（再次住院、急诊就诊）之间的关系。这项描述性、相关性研究在美国中西部一家大型四级NICU进行。对19名母亲进行了面对面访谈，她们的技术依赖型婴儿（如补充氧气、喂食管）将在2至3周内从NICU出院回家，访谈使用标准化工具。婴儿出院后头3个月的再次住院和急诊就诊数据从电子病历（EMR）中收集。分析包括描述性统计和负二项回归。大多数婴儿（72.2%）至少需要1次住院治疗；33%的婴儿至少需要1次急诊就诊。母亲的年龄和应变能力是急诊就诊的重要预测因素，而只有应变能力能预测再次住院情况。抑郁症状和创伤后应激症状均不能显著预测医疗保健利用情况。母亲的应变能力是唯一能显著预测急诊就诊和住院情况的主要变量，也是少数几个可改变的因素之一，能够帮助母亲成功应对照顾技术依赖型婴儿的复杂性。未来的研究应侧重于在技术依赖型婴儿从NICU出院前增强母亲应变能力的干预措施。
