Ueki Shingo, Fujita Ayaka, Kumagai Yukari, Hirai Yumi, Tashiro Eri, Miyata Junko
Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
School of Nursing, Daiichi University of Pharmacy, Fukuoka, Japan.
Int J Nurs Sci. 2022 Dec 21;10(1):82-88. doi: 10.1016/j.ijnss.2022.12.004. eCollection 2023 Jan.
This study aimed to identify clinical bottle-feeding techniques practiced by nurses for children with cleft lip and palate experiencing feeding difficulties.
A qualitative descriptive design was used. Five anonymous questionnaires were distributed to each hospital, and 1,109 hospitals with obstetrics, neonatology, or pediatric dentistry wards in Japan were enrolled in the survey between December 2021 and January 2022. Participants were nurses working for over 5 years providing nursing care for children with cleft lip and palate. The questionnaire comprised open-ended questions about the feeding techniques across four dimensions: preparation before bottle-feeding, nipple insertion methods, sucking assistance, and criteria for stopping bottle-feeding. The qualitative data obtained were categorized according to meaning similarity and analyzed.
A total of 410 valid responses were obtained. The findings regarding the feeding techniques in each dimension were as follows: seven categories (e.g., improving child's mouth movement, keeping child's breath calm), 27 sub-categories in preparation before bottle-feeding; four categories (e.g., closing the cleft using the nipple to create negative pressure in oral cavity, inserting the nipple to not touch the cleft), 11 sub-categories in nipple insertion methods; five categories (e.g., facilitating awakening, creating negative pressure in oral cavity), 13 sub-categories in sucking assistance; and four categories (e.g., reduced awakening level, worsening vital signs), 16 sub-categories in criteria for stopping bottle-feeding. Most participants responded that they would like to learn bottle-feeding techniques for children with cleft lip and palate who have feeding difficulties.
Many bottle-feeding techniques were identified to address disease-characterized conditions. However, the techniques were found to be conflicting: some inserted the nipple to close the cleft to create negative pressure in the child's oral cavity, while others inserted it without touching the cleft to prevent ulceration on the nasal septum. Although these techniques were used by nurses, the effectiveness of the methods has not been assessed. Future intervention studies are needed to determine each technique's benefit or potential harm.
本研究旨在确定护士针对唇腭裂患儿喂养困难所采用的奶瓶喂养临床技术。
采用定性描述性设计。向每家医院发放五份匿名问卷，2021年12月至2022年1月期间，日本1109家设有产科、新生儿科或儿童牙科病房的医院参与了调查。参与者为从事唇腭裂患儿护理工作超过5年的护士。问卷包括关于喂养技术的开放式问题，涉及四个方面：奶瓶喂养前的准备、奶嘴插入方法、吸吮辅助以及停止奶瓶喂养的标准。对获得的定性数据按意义相似性进行分类并分析。
共获得410份有效回复。各维度喂养技术的调查结果如下：奶瓶喂养前准备方面有七类（如改善患儿口腔运动、保持患儿呼吸平稳），27个亚类；奶嘴插入方法方面有四类（如用奶嘴封闭腭裂以在口腔内形成负压、插入奶嘴时不接触腭裂），11个亚类；吸吮辅助方面有五类（如促进觉醒、在口腔内形成负压），13个亚类；停止奶瓶喂养标准方面有四类（如觉醒水平降低、生命体征恶化），16个亚类。大多数参与者表示希望学习针对有喂养困难的唇腭裂患儿的奶瓶喂养技术。
确定了许多针对疾病特征情况的奶瓶喂养技术。然而，发现这些技术存在冲突：一些人插入奶嘴以封闭腭裂，在患儿口腔内形成负压，而另一些人插入奶嘴时不接触腭裂以防止鼻中隔溃疡。尽管护士使用了这些技术，但这些方法的有效性尚未评估。未来需要进行干预研究以确定每种技术的益处或潜在危害。
