有醫療需求之高危險嬰幼兒出院後居家照護之研究

A Study of Home Health Care for High-risk Infants and Toddlers with Medical Demand after Discharge from Hospitals

周治蕙(Chou Chih-Hui)

指導教授 ： 王天苗

國立臺灣師範大學/教育學院/特殊教育學系/博士(2011年)

摘要

本個案研究是以「台北市立聯合醫院附設婦幼居家護理所」為例，深入探討我國有醫療需求之高危險嬰幼兒出院後居家照護的供需情況及未來可能的作法。以個別訪談、焦點團體訪談為主，電話訪談、座談會、參與觀察、檔案文件查閱等為輔，蒐集研究資料。個別訪談個案母親，資深兒科護理師；焦點團體訪談婦幼居家護理所之護理行政人員、電話訪談台北市早期療育到宅服務之教保員。結果婦幼居家護理所可提供居家照護服務給居住在台北市及新北市有需要的嬰幼兒家庭。該所成立一年半以來，主要服務的對象是台北市立聯合醫院婦幼院區出生之非常低或極低出生體重早產兒、先天性異常、罕見疾病等嬰兒出院後之追蹤服務。雖然過去這類患孩的主護護士都會擬定出院準備計畫，也鼓勵並教導主要照顧者學習個別所需的特殊照顧技術（如使用氧氣、抽痰機，鼻胃管灌食），但在醫院由醫療專業人員提供照護與居家由家屬自行照顧之間的轉銜，確實是有需要由居家護理師進行家庭訪視，實地評估有醫療需求之嬰幼兒回家後的狀況並提供後續之護理服務。本研究發現8位高危險嬰幼兒大都呈現一年內再住院率高、有發展遲緩、體重增加不良等現象。建議政府儘早擬定兒童居家照護政策，協助有需求的家庭得到適當的持續照護服務。建議三歲以下高危險群嬰幼兒的母親們執行餵食母乳六個月以上、少帶幼兒去公共場所、積極參與早期療育活動等。

關鍵字

高危險嬰幼兒 ； 出院準備計畫 ； 居家照護 ； 早期療育 ； 轉銜服務

並列摘要

This research is a case study. By taking the “Taipei City Hospital Women and Children Home Care Institution” ( Fuyou Home Care Institution ) as an example to understand the supply and demand of home care for high-risk infants and toddlers with medical needs after discharge from hospitals, and to explore what can be done for them in the future. The data collection mainly adopt individual interviews and focus group interviews, and utilize telephone interviews, seminars, participant observation, and archival document review as supplements. Individual interviews were conducted with mothers of high-risk infants and toddlers as well as pediatric nursing staffs. Focus group interviews were conducted with nursing administration staffs from Fuyou Home Care Institution. Telephone interviews were conducted with home-based early childhood teachers of the early intervention in Taipei City.
Result: the Fuyou Home Care Institution was established in December, 2009 to offer home care service for people who need and live in Taipei City and Taipei County. In the beginning, the main service targets are very low or extremely low birth weight premature babies and congenital abnormality, rare diseases babies born in the Branch for Women & Children of Taipei City Hospital.
In past, the primary nurses of these kids always make discharge plan for them. By encouraging and teaching their main caregivers to learn some special techniques which these kids need at home (such as utilize oxygen, suction machine, nasal feeding etc.), the primary nurses prepare these caregivers to take over the care tasks. But, the shift between hospital-based care by professionals to home care by families require home care services to tailor. By assessing their residence environment and health condition after discharge, offering some advises and assistance, home care nurses’ transition service can help these families to take over the care tasks and diminish the chances of readmission.
The researcher suggest that the government should make a policy to provide home health care for children to early detect high-risk population and offer early intervention. For mothers of 0-3 years high-risk infants and toddlers, the researcher suggest them breast-feed their children for at least 6 months, avoid taking their children to public places, and actively participate in early intervention activities.

並列關鍵字

high-risk infant and toddler ； discharge planning ； home health care ； early intervention ； transition service

參考文獻

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