| 摘要: | 背景：國內早產兒出生比率約占8% -10.7%。隨著社會轉型，晚婚及不孕婦女比率增高，排卵藥物的使用和生殖科技的進步，使得多胎妊娠的發生率有增加的趨勢，產生早產兒機率增加。文獻指出早產兒的母親在醫院後返家的壓力大於足月兒母親，母育信心也比足月兒母親低；亦證實社會支持是對早產兒母親是重要的。但目前國內、外無對單胞胎與多胞胎早產兒母親的社會支持，與自覺壓力和母育信心相關性之研究。
目的：本研究目的是探討單胞胎與多胞胎早產兒母親在出院後一個月，其社會支持、自覺壓力和母育信心之相關性。
方法：研究採橫斷式調查法，以立意取樣的方式，收取符合收案條件之單胞胎與多胞胎早產兒母親為研究對象，共90位(單胞胎早產兒母親52位、多胞胎早產兒母親38位)。評量以自擬性問卷為測量工具，問卷內容含早產兒母親的基本資料及早產兒的基本資料共28題、社會支持量表採用Hays等(1995)的量表修正後21題、壓力知覺量表採Cohen等(1983)的量表修正後15題和Parker及Zahr (1985)自信度量表修正後18題。在早產兒出院回家照顧一個月後，以電話或門診追蹤的方式與母親聯繫，並徵求同意後以e-mail方式或現場填寫方式，完成問卷填寫。
結果：1.單胞胎與多胞胎早產兒母親在早產兒出院後一個月的社會支持，單胞胎平均得分為76.6分(總分104)，多胞胎平均得分為76.5分，都有達到7成以上的支持。2.自覺壓力部分，單胞胎早產兒母親平均得分為25.8分，介於偶爾及有時的壓力程度；多胞胎早產兒母親平均得分為31.0分，相當於有時的壓力程度；結果顯示多胞胎早產兒的母親自覺壓力高於單胞胎早產兒母親。3.母育信心部分(總分90)，單胞胎早產兒母親平均得分為65.67分，多胞胎早產兒母親平均得分為62.18分；即早產兒母親在出院後一個月，對照護嬰兒都有七成的信心把握，結果顯示單胞胎早產兒母親在母育信心高於多胞胎早產兒母親。4.影響單胞胎早產兒母親自覺壓力的相關因素為：(1)教育程度(2)協助照顧嬰兒的對象是婆婆(3)自覺健康狀況(4)每日睡眠時間(5)自覺睡眠品質(6)出生週數(7)社會支持有關。可預測單胞胎早產兒母親自覺壓力之因子為社會支持。5.多胞胎早產兒母親自覺壓力的相關因素為：(1)是否有他人協助照顧嬰兒(2)每日睡眠時間(3)自覺睡眠品質(4) 社會支持中的具體支持及情感資訊支持。可預測之因子為每日睡眠時間。6.影響單胞胎早產兒母親母育信心之相關因素及預測因子皆是：(1)教育程度(2)平均早產兒出生體重(3)協助照護嬰兒的對象是產婦的母親。7.影響多胞胎早產兒母親母育信心之相關因素是早產兒出院體重。
結論與建議：1.建議臨床護理實務建立多胞胎與家庭相關的元素及概念及其護理路徑。.2.護理臨床教育育應加強護理人員能力，協助早產兒母親對早產兒照護知能及解決問題，為居家照護做充分準備。3.早產兒返家前的學習照護成員應包含早產兒父親，以提供早產兒母親社會支持。4.養成教育與在職教育應將增加雙胞胎及多胞胎身、心發展及照護之議題。5.護理人員可扮演轉介者的角色，幫助早產兒母親善用社會資源，參與自助團體，取得更多的社會支持。
Background: The domestic of premature birth rate is about 8% -10.7%. With the social transformation, ratios of late marriage and infertility have been increased. The use of fertility medicine and advances in reproductive technology make an increased incidence of multiple births, which also increase the preterm infants. Literature indicates that preterm mother in the hospital after the pressure is greater than full-term mothers. Maternal confidence of being a premature mother was lower than full-term mothers’. The literature also confirms that the social support is very important for mothers with preterm infant. But the relationship between mothers with preterm infants’ social support, perceived stress and maternal confidence in mothers with singleton and multiple births preterm infant have not been explored yet.
Purpose：The Purpose of study is to explore the relationships between the social support, perceived stress and maternal confidence in mothers with singleton and multiple births preterm infant at one month after discharge.
Methods：The study is a cross-sectional designed. Data were collected by purposive sampling. A total of 90 parents (52 single birth of premature mothers, 38 multiple birth of premature mothers) were recruited. The measurement are self-developed questionnaire with 28questions including both mother and infant’s basic information, 21 items of revised Social Support Scale (Hays, 1995), 15 items of revised Perceived Stress Scale (Cohen, 1983), and 18 items of revised Maternal Confidence Scale (Parker and Zahr, 1985). After preterm infant discharge one month at home, participants will be informed, and fill out the questionnaire by email or present in outpatient unit.
Results：1. Mothers’ social support at one month after discharge from hospital, average score is 76.6 in singleton birth and 76.5 in multiple birth (total score 104), which above 70% of social support. 2. Perceived stress, average score is 25.8 in singleton birth mothers, which is between occasional and sometimes stress levels; average score is 31.0 in multiple birth mothers, which is between equivalent levels of stress. That indicates that mother with multiple birth perceived pressure is higher than single births’. 3. Maternal Confidence (total score 90), average score is 65.67 in single birth mothers and 62.18 in multiple birth mothers. This indicates about 70% maternal confidence are showed in both group of mothers. 4. Related factors of singleton birth mothers’ perceived stress are: (1) education (2) mother-in-law is baby care assistant (3) self perceived health status (4) daily sleep time (5) perceived quality of sleep (6) infants’ birth age, and (7) social support. The predict factor of singleton births of mothers’ perceived stress factor is social support. 5. Related factors of multiple birth mothers’ perceived stress are: (1) have/ no helper to take care of the baby (2) daily sleep time (3) perceived sleep quality, and (4) tangible support and emotional / information support . The predict factor of multiple births of mothers’ perceived stress factor is daily sleep time. 6. The effect and predict factors of singleton birth mother's maternal confidence are: (1) education (2) the average birth weight of preterm infant (3) mother (case’s mother) is baby care assistance. 7. The related factor of multiple birth mothers’ maternal confidence is premature infant’s weight at discharged.
Conclusions：1. We recommend that multiple births and family-related information should be established in clinical path way. 2. In clinical continuing education, nurses should be strengthen on their capacity to assist mothers with preterm children. To sharpen mothers’ child care knowledge and solving problems, appropriate preparation for home care will be provided. 3. Father is an important support of mother with preterm infant; he should be included in infants’ discharged plan. 4. Twins or multiple births’ care should be included in school education and in-service education. 5. Nurses play a role of advocator, who can help mothers to involve in the self assistant group and information, to promote more social support for mother with preterm infants. |
