| Objective1. To explore the parenting experience and psychological process after discharge in parents of very low birth weight premature infants through the phenomenological research.2. To establish the Transitional Care Model of very low birth weight premature infants and develop nursing prescriptions in different stages.3. To develop evaluation criterion for continuing health education in parents of very low birth weight premature infants and Continuing Care Satisfaction Scale for premature infants’ parents, which can be used as an effective tool for premature infants Continuing care service.4. To evaluate the feasibility and effectiveness of continuing care on infants’ intellectual development, physical development, temperament, readmission rate as well as mothers’ psychological state, parenting stress state and satisfaction for nursing service. To explore the influence factors of mothers’ psychological state so as to provide reference evidence for psychological intervention.Methods1. The semi-structured in-depth interview and participant observation method were adopted to conduct qualitative interview with parents of very low birth weight premature infants. The content of the interview was arranged and analyzed by Colaizzi analytical method and Triangulation method with the aid of Nvivo8software.2. The Transitional Care Model was established and nursing prescription was developed on the basis of in-depth interview with parents, group focus interview with medical staff and Delphi technique.3. The literature review, qualitative interview and Delphi technique were conducted to identify the evaluation criterion for continuing health education in parents of very low birth weight premature infants and Continuing Care Satisfaction Scale for premature infants’ parents. The content validity, construct validity, internal consistency reliability and test-retest reliability of the scale were tested.4. Randomized controlled clinical research method was employed.100cases from Fujian Provincial Maternity and Children’s Hospital were recruited and randomly divided into two groups from November in2012to April in2013. A total of89cases completed the research. Both groups were given conventional care and the experimental group received the Transitional Care Model. Infants’ score of neuropsychological development examination, EITQ, TT, height, weight, head circumference, readmission rate and mothers’ score of SCL-90, PSI-SF, evaluation criterion for continuing health education and Continuing Care Satisfaction Scale were collected at the2nd,3rd,4th,6th,8th,10th and12th month of the infants. Two-sample t(t’) test, Mann-Whitney U rank sum test, Chi-square analysis, Fisher probability and repetitive measure ANOVA were used to evaluate the effect of the continuing care model. One-way ANOVA, Kruskal Wallis H test, Pearson correlation analysis, multiple1inear stepwise regression analysis were used to analyze the influence factors.Results1. Parents were under psychological pressure, social impact and financial burden. They were full of frustration, helplessness and anxiety when faced with parenting. There were deviations from the parents’ understanding of infants’ long-term life quality. They were also lack of awareness of continuing care and showed urgent demands for continuing care.2. The Transitional Care Model which was based on the holistic nursing care, Erikson’s personality development theory and piaget’s cognitive development theory was divided into five categories and four areas with nursing process as a framework. The content was more specific and comprehensive. Nursing prescriptions which highlighted the personalized characteristic contained of schemes of diet, sleep health care, potential development, sight and hearing care, rehabilitation and health education.3.①The evaluation criterion for continuing health education in parents of very low birth weight premature infants consisted of3projects with29specific items. The content validity index for the scale was0.944. Three common factors were extracted by the principal components extraction analysis and the cumulative contribution rate was49.70%,73.25%and46.90%respectively. The Cronbach’s alpha coefficient was0.934, the retest reliability was0.865and the ICC was0.940for the total scale.②The Continuing Care Satisfaction Scale for premature infants’ parents consisted of21specific items. The content validity index for the scale was0.964. Four factors were extracted by principal components extraction analysis and totally explained60.57%of the variance. The Cronbach’s alpha coefficient was0.910and the test-retest reliability coefficient was0.807.4.①The results of repeated-measures analysis of variance indicated that the total and each area DQ of infants in the experimental group were higher than the control group (P<0.001); The results of repetitive measure ANOVA also showed that the height and weight of the experimental group were slightly higher than the control group (P<0.05).②After the intervention, infants with temperament type of merged E in the experimental group were more than those in the control group (P<0.01). The scores of rhythmic and adaptability dimension in the experimental group were lower than those in the control group (P<0.05).③The readmission rate in the experimental group was lower than that in the control group (P<0.05).④The results of repetitive measure ANOVA showed that mothers in the experimental group had lower scores of average SCL-90, depression and anxiety factor (P<0.05) as well as low total PSI-SF scores (P<0.001). In each point of time after the intervention, the mothers in the experimental group who showed positive parenting stress were lower than the control group (P<0.001).⑤Statistical differences in evaluation criterion scores were identified between the two groups at infants’6th and12th month respectively after intervention(P<0.05)．Mothers in the experimental group had higher scores in Continuing Care Satisfaction Scale (P<0.01).⑥The results of multiple1inear stepwise regression analysis indicated that the factors which entered into SCL-90regression equation were asphyxia after birth, total mental age at the2nd month and results of NBNA screening (R2=0.568); the factors which entered into force regression equation were height at the2nd month and the history of asphyxia after birth (R2=0.250); the factors which entered into depression regression equation were PSI-SF scores, asphyxia after birth and results of NBNA screening (R2=0.448); the factors which entered into anxiety regression equation were mothers’ education background, NBNA screening results and total mental age at the2nd month (R2=0.604); the height at the2nd month, singletons and twins born and the history of asphyxia after birth entered into the additional factors regression equation (R2=0.389). The results of correlation analysis showed that the scores of mothers’ depression, anxiety, psychoticism factor, SCL-90were correlated with PSI-SF scores highly before intervention (P<0.001).Conclusion1. The nursing staff should provide individual psychological intervention, social support and optimize structure of parenting knowledge for parents.2. The evaluation criterion for continuing health education in parents of very low birth weight premature infants and Continuing Care Satisfaction Scale for premature infants’ parents have good reliability and validity. The scales embody the connotation of Continuing Care and could be used as the tool for testing and evaluating the effect of premature infants continuing nursing health education and Continuing Care Service.3. The Transitional Care Model can promote infants’ intellectual development, cultivate the temperament, reduce the readmission rate, alleviate the mothers’ depression, anxiety and stress state, promote the mothers’ parenting knowledge structure and improve the nursing service satisfaction. But the model has less influence on infants’ physical development.4. The key mental monitoring and intervention targets are mothers whose infants with asphyxia after birth, low mental age at the2nd month, positive NBNA screening and short stature. The mothers who have twin premature infants with very low birth weight, higher educational level and higher scores of PSI-SF,“parental distress” and “having a difficult child” are also the major targets. |
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