入院待產時機教育課程於孕婦焦慮、不確定感、生產控制感及待產結果之成效

Effectiveness of a Labor-Admission Education Program on Anxiety, Uncertainty, Locus of Labor Control, and Labor Outcomes in Pregnant Women

梁慧敏(Hui-Min LIANG) ； 高美玲(Meei-Ling GAU) ； 陳治平(Chie-Pein CHEN) ； 劉介宇(Chieh-Yu LIU)

《護理雜誌》 66卷2期 (2019/04) Pp. 36-47

https://doi.org/10.6224/JN.201904_66(2).06

摘要

背景：過早入院到陌生醫療場景待產易使孕婦產生焦慮、不確定及失控感，教育孕婦等待適當入院時機，能減少往返產房與家中的辛苦，降低非必要醫療措施。目的：探討入院待產時機教育課程於孕婦焦慮、不確定感、生產控制感及待產結果之成效。方法：採類實驗設計，共收151位低危險群之單胞胎初孕婦，實驗組76位於妊娠35週以上的產檢日接受入院待產時機教育課程，課程次數為一次，共計一小時，課程內容分為三單元：「正常產兆與待產時機」、「產兆來臨之居家備忘錄」、「危險徵兆的認識」；控制組75位未接受。於介入方案前及產後3天內填寫結構式問卷：基本人口產科學資料、焦慮感與不確定感視覺類比量表、生產控制感量表以及待產結果資料。結果：入院待產時機教育課程能降低孕婦焦慮及不確定感（p ＜ .001）、提高生產控制感（p = .001），掌握較正確入院時機（p = .001）、減少被拒絕入院返往家中的次數（p = .007）及諮詢次數（p ＜ .001），提高子宮頸擴張達3公分後入院的比率（p ＜ .001）以及降低催生機會（p = .002）。結論／實務應用：藉由入院待產時機教育課程，鼓勵孕婦無危險徵兆時，延長第一產程潛伏期居家時間，以降低焦慮、不確定感，提高生產控制感及較佳待產結果。

關鍵字

入院待產時機教育課程 ； 焦慮感 ； 不確定感 ； 生產控制感 ； 待產結果

並列摘要

Background: The process of hospital admission undergone by expectant mothers readily induces feelings of loss of control, anxiousness, and uncertainty. Thus, education to promote the proper response of women to their impending hospital admission may be beneficial in terms of minimizing the number of labor-related hospital trips and the wastage of medical resources. Purpose: To explore the effects a labor-admission education program on perceived anxiousness, uncertainty, locus of control, and labor outcomes in expectant mothers. Methods: A quasi-experimental research design was used to recruit participants. Eligible participants were primipara women who were expected to experience a complications-free pregnancy with a single fetus. A total of 151 participants were enrolled, with 76 assigned to the experimental group and 75 assigned to the control group. The experimental group received the labor and delivery education program intervention while the control group received standard nursing guidance. Participants received the education program in their regular prenatal checkup after the 35th gestational week. The intervention (education program) lasted an hour and included three parts: normal labor signs and appropriate timing of labor admission, self-care strategies at home, and indicators of the onset of labor. A structured questionnaire, including a basic OB/GYN datasheet, the Visual Analogue Scale (VAS) of uncertainty and anxiety, the Labor Agentry Scale (LAS), and birth-outcome information, was used to collect data. Participants completed the three scales at two time points: 1) prior to admission and after the education program and 2) at 3-days postpartum. Results: The findings support the effectiveness of providing a pre-admission education program in terms of lowering perceived uncertainty and anxiousness (p ＜ .001), enhancing the locus of control during birth (p = .001), increasing awareness of the proper time for admission after the onset of labor (p = .001), and reducing the numbers of repeat trips to the hospital (p = .007) and consultations (p ＜ .001). Further, the education program may improve the rate of 3cm-or-greater cervical dilation at admission (p ＜ .001) and reduce the need for induced deliveries (p = .002). Conclusions/Implications for Practice: In the absence of contraindications, this education program should be provided to expectant mothers as an effective method to maximize the duration of the at-home, latent phase of labor in order to increase locus of control over delivery, reduce uncertainty and anxiousness, and attain optimal birth outcomes.

並列關鍵字

timing of admission in labor of educational program ； anxiety ； uncertainty ； labor-related locus of control ； labor outcomes

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