Abstract:

Objective　To explore the application effect of continuous nursing intervention in the discharge follow-up of critically ill neonates under the framework of Omaha system. Methods　It was a prospective randomized controlled trial. From July 2020 to July 2022, 84 critically ill neonates and their main guardians in neonatal intensive care unit (NICU) of Children's Hospital Affiliated of Zhengzhou University were enrolled in the study. According to the random number table method, they were divided into a control group [24 males and 18 females in 42 neonates; 37 males and 5 females in 42 guardians, aged (31.14±4.46) years] and an observation group [21 males and 21 females in 42 neonates; 39 males and 3 females in 42 guardians, aged (31.30±3.38) years]. Routine continuous nursing intervention was given to the control group. On the basis of the control group, the observation group carried out continuous nursing intervention based on the framework of Omaha system. The main guardians' mental status [Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) as comprehensive assessment tools], sense of uncertainty of disease and attachment emotion [the Chinese version of the Revised Parental Uncertainty Scale (PPUS) and the Chinese version of the Parent Peer Attachment Scale (IPPA-R) as assessment tools], and nursing ability [Simple Coping Style Scale (SCSQ) as an assessment tool] and critically ill neonates' nursing problems, quality of life [Universal Core Quality of Life Scale (PedsQL^TM 4.0) as an assessment tool], and adverse events at the time of discharge and 4 weeks of follow-up were compared between the two groups. t test and χ² test were used. Results　After nursing, the SAS score [(32.64±6.27) points], SDS score [(33.69±4.82) points], and PPUS score [(59.47±7.33) points] in the observation group were all lower than those in the control group [(43.61±9.97) points, (45.16±8.15) points, and (73.42±6.99) points], and the IPPA-R score [(101.28±11.89) points] was higher than that in the control group [(87.24±12.27) points], with statistically significant differences (all P<0.05). After nursing, the positive coping score of the SCSQ [(39.82±3.48) points] in the observation group was higher than that in the control group [(34.73±6.63) points], and the negative coping score [(17.23±3.10) points] was lower than that in the control group [(21.76±2.94) points], with statistically significant differences (both P<0.05). After nursing, the rates of environmental [9.52% (4/42)], social psychological [14.29% (6/42)], physiological [16.67% (7/42)], and health behavioral nursing problems [14.29% (6/42)] in the observation group were lower than those in the control group [28.57% (12/42), 35.71% (15/42), 42.86% (18/42), and 40.48% (17/42)], with statistically significant differences (all P<0.05). After nursing, the PedsQL^TM 4.0 score [(69.34±11.88) points] in the observation group was higher than that in the control group [(60.26±6.24) points], and the incidence of adverse events [7.14% (3/42)] was lower than that in the control group [26.19% (11/42)], with statistically significant differences (both P<0.05). Conclusion　The application of continuous nursing intervention under the framework of Omaha system in the discharge follow-up is helpful to improve the main guardians' mental state, reduce the uncertainty of disease, enhance the attachment, and significantly improve their nursing ability, which can also reduce the critically ill neonates' nursing problems, improve their quality of life, and reduce the occurrence of adverse events.

Key words:

Continuing nursing intervention, Omaha system, Critically ill neonates, Discharge follow-up

摘要：

目的　探讨奥马哈系统框架下开展延续护理干预在重症新生儿出院随访中的应用效果。方法　前瞻性随机对照试验，选取2020年7月至2022年7月郑州大学附属儿童医院新生儿重症监护室（NICU）收治84例重症新生儿及主要监护人开展研究，按随机数字表法分为对照组［重症新生儿42例，其中男24例、女18例；主要监护人42例，其中男37例、女5例，年龄（31.14±4.46）岁］及观察组［重症新生儿42例，其中男21例、女21例；主要监护人42例，其中男39例、女3例，年龄（31.30±3.38）岁］。对照组给予常规延续护理干预，观察组在对照组基础上基于奥马哈系统框架下开展延续护理干预。比较两组出院时、出院随访4周主要监护人心理状态［以焦虑自评量表（SAS）、抑郁自评量表（SDS）作综合评估］、疾病不确定感及依恋情感［分别用中文版修订疾病不确定感父母量表（PPUS）及中文版父母同伴依恋量表（IPPA-R）进行评价］、照护能力［以简易应对方式量表（SCSQ）进行评估］以及重症新生儿护理问题、生活质量［以生活质量普适性核心量表（PedsQL^TM 4.0）进行评估］及不良事件。采用t检验、χ²检验。结果　护理后，观察组SAS评分［（32.64±6.27）分］、SDS评分［（33.69±4.82）分］、PPUS评分［（59.47±7.33）分］均低于对照组［（43.61±9.97）分、（45.16±8.15）分、（73.42±6.99）分］，IPPA-R评分［（101.28±11.89）分］高于对照组［（87.24±12.27）分］，差异均有统计学意义（均P<0.05）。护理后，观察组SCSQ中积极应对评分［（39.82±3.48）分］高于对照组［（34.73±6.63）分］，消极应对评分［（17.23±3.10）分］低于对照组［（21.76±2.94）分］，差异均有统计学意义（均P<0.05）。护理后，观察组环境［9.52%（4/42）］、社会心理［14.29%（6/42）］、生理［16.67%（7/42）］、健康行为领域护理问题比例［14.29%（6/42）］均低于对照组［28.57%（12/42）、35.71%（15/42）、42.86%（18/42）、40.48%（17/42）］，差异均有统计学意义（P<0.05）。护理后，观察组PedsQL^TM 4.0评分［（69.34±11.88）分］高于对照组［（60.26±6.24）分］，不良事件发生率［7.14%（3/42）］低于对照组［26.19%（11/42）］，差异均有统计学意义（均P<0.05）。结论　出院随访中应用奥马哈系统框架下开展延续护理干预有助于改善重症新生儿主要监护人心理状态，减轻疾病不确定感，并增强依恋情感，且照护能力有明显提高，可减少重症新生儿护理问题，提高生活质量，并降低不良事件发生。

关键词:

延续护理干预, 奥马哈系统, 重症新生儿, 出院随访