护患关系模式对自然分娩后母亲行为影响的研究

目的 研究比较两种护患关系模式对自然分娩后产妇行为的影响。方法 对2003年在我院住院并自然分娩的80例产妇实施整体护理。其中40例护患关系模式为共同参与型(参与组)，另外40例为指导合作型(指导组)。两组产妇在产后自理能力，进入母亲执行期时间及主动寻求知识提问率三方面进行比较。结果 参与组产妇比指导组产妇产后自理能力强，进入母亲执行期时间短，主动提问率高。结论 护患关系模式对产后母亲行为有重要影响。共同参与模式对产后母亲行为在自理能力、母亲角色转化及寻求知识方面起着积极作用，优于指导合作模式。     

对自然分娩与剖宫产产妇产后行为适应的调查研究

目的 :为识别目前产妇产后行为的调适过程。方法 :设计产后行为调查表 ,根据调查表对 1998年 4～ 5月在我院分娩的 6 0例产妇的产后调适行为进行分析。结果 :剖宫产产妇进入母亲执行期的时间最快者为 16 1h ,最慢者为 5 5 2h ,平均时间为 30 4h。经阴道分娩的产妇进入执行期的时间最快者仅需要 3h ,最慢者为 2 3 9h ,平均为12 2h。运用t检验 ,两种方式分娩的产妇进入执行期的时间比较有显著性差异 (P <0 0 1)。结论 :分娩方式对产妇进入执行期的时间有重要影响。上述产妇进入执行期的时间较Rubin分期或最近的国外分期提前 ,本文结合民族文化背景讨论了产生这种差异的原因     

护患共同参与模式对肝硬化患者心理行为的影响

目的：探讨护患共同参与模式对肝硬化患者心理行为的影响，以使病人主动参与健康决策和促进自我护理。方法：对2002年12月。20Q3年12月在我院住院的80例肝硬化患者实施整体护理，其中40例为护患共同参与模式(参与组)。另外40例为护患指导合作模式(指导组)。结果：参与组肝硬化患者在保持情绪稳定、改变不良饮食习惯、合理安排休息和运动、自行掌握用药方面均优于指导组，且患者的并发症发生率降低。结论：护患共同参与模式对肝硬化患者心理、行为起积极作用，优于指导模式，同时对缩短患者的平均住院日，提高生命质量有重要意义。     

新生儿性别对剖宫产产妇的影响与护理干预

目的 :探讨新生儿性别对剖宫产产妇的心理和生理影响。方法 :将实施剖宫产手术的产妇 12 5例分为两组 ,女婴组 6 0例 ,男婴组 6 5例 ,观察两组产妇术后的精神状态、出血量、泌乳量、自理能力。结果 :两组比较差异有显著性 (P <0 0 5 )。女婴组的产妇产后抑郁病率高 ,出血量多 ,泌乳量少 ,自理能力强。结论 :医护人员应重视生女婴产妇的心理护理。     

健康教育与行为指导对剖宫产产妇母乳喂养的效果

目的对剖宫产产妇术后应用健康教育与行为指导在母乳喂养方面的影响进行探讨。方法选取2017年6月—12月进入本院行剖宫产分娩的产妇共100例,采用随机数字法分为观察组及对照组,每组各50人。实施健康教育与行为指导干预者为观察组,实施常规护理干预者为对照组。结果母乳喂养知识技能掌握情况方面,观察组产妇出院时的知识掌握优良率为98. 00%,对照组为80. 00%,差异存在统计学意义(P 0. 05)。母乳喂养情况方面,观察组和对照组的纯母乳喂养率分别为92. 00%、78. 00%,差异存在统计学意义(P 0. 05)。结论加快产后恢复的基础上提高剖宫产产妇母乳喂养率,实施健康教育与行为指导干预是十分必要的。     

剖宫产产妇自理能力的调查与护理对策

目的 :探讨恢复剖宫产产妇自理能力的相关因素及护理对策。方法 :自行设计剖宫产产妇自理能力调查表 ,调查 80例剖宫产产妇术后 5d的自理能力。结果 :进行健康教育遵医行为较好的产妇自理能力强 ;城市、文化层次高的产妇自理能力优于农村、文化水平低的产妇 ,新式剖宫产的产妇术后自理能力显著优于传统剖宫产者 ,(P <0 0 1,<0 0 5 )。结论 :开展新式剖宫产术 ,加强孕产妇健康教育 ,提高了自我保健意识 ,有效地促进了产妇的身心健康     

不同护理模式对剖宫产术后产妇自理能力的影响

2003年6月～2004年7月,我院对140例接受剖宫产术的产妇分组实施指导合作型与护患共同参与型护理模式,并观察比较两组的临床效果,现报告如下.     

不同护理模式对剖宫产术后产妇自理能力的影响

2003年6月-2004年7月，我院对140例接受剖宫产术的产妇分组实施指导合作型与护患共同参与型护理模式，并观察比较两组的临床效果，现报告如下。     

行为干预对剖宫产初产妇产后喂养的影响

目的：探讨行为干预对剖宫产后初产妇自我能效对产后喂养的影响。方法选取我院剖宫产初产妇204例,将2011年7月至2012年9月入院行剖宫产分娩产妇为对照组,将2012年10月至2013年12月入院行剖宫产分娩的产妇为观察组,每组102例。对照组产妇实施健康教育、心理护理、基础护理与喂养护理四位一体的护理模式,观察组产妇从认知行为、心理行为、饮食行为、信息支持四个方面进行综合干预。评价两组产妇产后1w内母乳喂养自我能效情况。结果观察组产妇自我能效评分明显高于对照组（ P＝0．028）。影响产妇产后能效因素分别术后进食,情绪,睡眠时间与食欲,经组合干预母乳喂养自信明显提高。结论对剖宫产初产妇行为干预后可提高母乳喂养自信,生产后可顺利进行母乳喂养提高能效,应针对直接影响因素进行干预,保证产妇产后顺利哺乳。     

临床路径在择期剖宫产术产妇中的应用

目的研究临床路径在择期剖宫产术产妇中的应用效果。方法将100例择期剖宫产术产妇随机分为试验组和对照组，每组50例。试验组按制定好的医、护、患临床路径实施每日诊疗、护理、康复工作，对照组采用传统医疗护理方法。结果试验组平均住院日、平均住院费用明显低于对照组（P〈0．05）；产妇满意度和健康知识评分明显高于对照组。结论按临床路径实施诊疗、护理及产妇的自理康复，可以减少平均住院日，降低住院费用，有利于产妇主动参与诊疗和护理，促进了产妇术后生活自理能力的恢复，提高了产妇满意度。     

The effectiveness of a Chinese midwives’ antenatal clinic service on childbirth outcomes for primipare: A randomised controlled trial

Background

Antenatal care is an important component of maternity care. In many parts of the world, midwives are the primary caregivers for childbearing women, providing a high level of continuity of care during a normal pregnancy. While in China, obstetricians are the primary providers of antenatal care for all childbearing women; and midwives only provide intrapartum care to labouring women. Today midwifery as a profession in China has been marginalised. Pregnant women usually lack individualised continuity of care from midwives during the perinatal period. There have been few randomised controlled trials of midwifery care practice in mainland China.

Objective

(1) To develop and implement a model of Chinese midwives’ antenatal clinic service and (2) to explore its effect on childbirth outcomes, psychological state and satisfaction, for primiparae.

Design and methods

Two-group randomised controlled trial. One hundred and ten pregnant women were assessed for eligibility and invited to participate in either the intervention group (midwives’ antenatal clinic service) or the control group (routine antenatal care) in the Obstetrics and Gynaecology Hospital of Fudan University from September 2011 to December 2011. Baseline data were collected, and then women were randomised to individual midwives’ antenatal clinic care (intervention group) or regular antenatal clinic service by obstetricians and obstetric nurse (control group). The research hypothesis was that compared with regular obstetrician-led antenatal care, the midwives’ antenatal clinic service would decrease the caesarean section rate, produce more favourable birth outcomes and women's greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. The sample size of 110 was calculated to identify a decrease in caesarean birth from 70% to 40%. Birth outcomes, satisfaction and anxiety score in the two groups were compared.

Setting

The midwives’ antenatal clinic in the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China.

Participants

55 women, attending the midwives’ antenatal clinic (the intervention group) and 55 women, entering the control group.

Results

Women in the intervention group were more likely than women in the control group to have a vaginal birth (35 [66.04%] versus 23 [43.40%]; 95% CI for difference 3.69–41.60). Women in the intervention group had a higher perinatal satisfaction but lower anxiety score than those in the control group. No differences were seen in neonatal Apgar score and in the amount of bleeding 2 h post partum.

Conclusion and implications for practice

The midwives’ antenatal clinic can decrease the rate of caesarean section and enhance women's satisfaction with midwifery care. Further research needs to be conducted to implement this model of care more widely. We will attempt to make midwifery care a true choice for Chinese women.     

护理干预对基层医院剖宫产率的影响

目的 观察护理干预对基层医院剖宫产率的影响.方法 选择240例待分娩产妇,按住院顺序随机分成实验组和对照组各120例.实验组产妇在整个分娩过程中,采用护理新模式给予护理干预.对照组产妇只按常规程序分娩.比较2组产妇的剖官产率,进行χ2检验.结果 实验组产妇剖官产率明显低于对照组.结论 护理干预对降低基层医院剖宫产率有一定的影响.     

护理干预对基层医院剖宫产率的影响

目的观察护理干预对基层医院剖宫产率的影响。方法选择240例待分娩产妇,按住院顺序随机分成实验组和对照组各120例。实验组产妇在整个分娩过程中,采用护理新模式给予护理干预,对照组产妇只按常规程序分娩。比较2组产妇的剖宫产率,进行χ^2检验。结果实验组产妇剖宫产率明显低于对照组。结论护理干预对降低基层医院剖宫产率有一定的影响。     

The course of pregnancy and fetal outcome after cesarean section

The management of pregnant women with a history of one or more previous caesarean sections has gained enormous importance in view of the increased frequency of delivery by this operative procedure over the past decade. The risks of pregnancy and delivery in this particular group of women have been investigated in this statistical study of 316 women, whereby special attention has been paid to the mode of delivery and fetal outcome in comparison with a matched-pair group of the same parity. Repeat caesarean section was required in 58.9% of the test group and vacuum extraction or forceps delivery was necessary in 7.9% of cases, the incidence of these operative procedures being far higher than in the control group. However, the fetal outcome was very similar in both groups, with an uncorrected perinatal mortality of 2.5% and 1.9% in the test and control groups, respectively. The 1' and 5' Apgar scores were worse in those newborn infants delivered by vaginal operation or emergency caesarian section. The vaginal delivery of women with a history of caesarean section is not only perfectly feasible, but is connected with little risk provided mother and fetus are monitored with utmost care.     

Health practices of adult Hispanic women

The purpose of this focused ethnography was to discover the patterns and variability of health practices used by Hispanic women aged 20-40 years. Seven adult Hispanic women from an urban New Mexico county were interviewed four to seven times each about their health practices. The women described their views of good health. They were aware of current health promotion practices such as good nutrition and exercise. They also practised safety measures for themselves and their families. These women did not report any information on specific cultural disease prevention behaviours and described few practices related to their Hispanic culture. A theme that also emerged from the data was an emphasis on the importance of spirituality and the integration of the spiritual dimension as important to healthy living. Implications for health care providers include knowing that urban adult Hispanic women are versed in contemporary health literature and take better care of their families than of themselves.     

39例重度子痫前期患者临床护理分析

目的:探讨重度子痫前期患者的护理方法。方法:对39例重度子痫前期患者进行精心的心理护理和预防子痫护理,合理掌握终止妊娠的时间,并做好分娩前后的护理。结果:本组患者均行剖宫产终止妊娠,术后产妇恢复良好,新生儿健康。本组均痊愈出院。结论:对重度子痫前期患者进行精心护理,可提高治疗效果及产科护理质量。     

Vulnerable and strong--lesbian women encountering maternity care

AIM: This paper is a report of a study to describe the maternity care experiences narrated by a sample of lesbian couples. BACKGROUND: Pregnant and labouring women are dependent on the professional skill and caring ability of the healthcare provider. Studies show that lesbian women who reveal their sexual identity are exposed to homophobic prejudice and discrimination in midwifery care. METHOD: A phenomenological hermeneutical study inspired by the French philosopher Paul Ricoeur was conducted. Six lesbian couples were recruited in Norway by a snowball method, reporting a total of eight children conceived by donor insemination. Joint interviews were performed in January 2006, and the participants were encouraged to share narratives about important events in their maternity care experiences. FINDINGS: The fundamental life conditions of vulnerability, responsibility and caring permeated the narratives, and were related with the couples' decisions to be open about their sexual identity. Being exposed, they experienced under- and over-focusing on sexuality. They felt responsible for having the right attitude in interactions, which meant being open, but not over-assertive. They described genuinely caring situations as well as being content with less genuine care, and demonstrated that in addition to receiving care, they provided care in the encounters. CONCLUSION: Lesbian women are a vulnerable group when encountering maternity care. They took responsibility in caring situations because of healthcare providers' uncertainty and anxiety. Existential needs, such as being seen, being cared for and communicated with, should be considered equally important for lesbian women and heterosexual women in labour.     

有剖宫产史孕妇再次妊娠分娩方式的探讨

目的：探讨剖宫产术后再次妊娠分娩的最佳方式。方法：回顾分析上海交通大学医学院附属瑞金医院2004年1月—2012年9月剖宫产术后再次妊娠的286例孕妇的分娩方式,其中剖宫产234例,阴道试产52例,并随机抽取同期首次行剖宫产术300例孕妇为对照组。结果：286例孕妇中258例（90.2%）再次行剖宫产术,28例阴道分娩,试产成功率53.9%。阴道分娩组无大出血发生,再次剖宫产组发生10例（3.88%）,对照组发生2例（0.67%）,差异有统计学意义（P〈0.05）。再次剖宫产组术中出血量（325.4±12.5）mL,高于对照组（225.6±26.8）mL及阴道分娩组（148.4±15.7）mL,差异有统计学意义（P〈0.05）。再次剖宫产组平均手术时间（59.2±20.5）min,高于对照组（30.9±14.6）min;腹腔粘连146例（56.59%）,高于对照组0例,差异均有统计学意义（P〈0.05和0.01）。再次剖宫产组住院时间（7.2±0.9）d,与对照组（6.8±1.2）d和阴道分娩组（3.5±1.8）d比较,差异有统计学意义（P〈0.05）。结论：瘢痕子宫再次妊娠不是剖宫产的绝对指征。有剖宫产史孕妇再次妊娠后,若无剖宫产指征,应增加阴道试产机会;而提高剖宫产手术水平,是降低剖宫产史孕妇再次剖宫产并发症的关键。     

妊娠期糖尿病母婴预后的临床分析

目的：探讨妊娠期糖尿病(GDM)对母婴预后的影响。方法：回顾性分析1998年12月～2000年12月期间，28例GDM，100例无内科合并症健康孕妇的妊娠结局。结果：GDM组病理妊娠发病率50％，剖宫产率60．71％，围产儿发病率64．28％，与对照组相比均有显著差异。结论：GDM组母婴发病率及手术产率均高于对照组，应提高对GDM的认识，减少母婴并发症的发生。     

An emic view of caring for self: grandmothers who care for children of mothers with substance use disorders

In the US more than 3.4 million children live with a mother who has a substance abuse disorder (SUD) and at some time in their life will be cared for by a grandmother. Most studies have focused on the economic, physical and emotional burdens of the conflated role of mother/grandmother. This study explores how 11 grandmothers cared for themselves while caring for the children of mothers with SUDs. The domain of inquiry was the self-care practices of grandmothers from an emic (generic) view. An assumption of the study was that the grandmothers represent a unique sub culture of women with particular beliefs, values and practices. An ethnographic approach was used to collect data from observations, in-depth interviews, and participant observation in various community settings. Patterns and themes revealed relational aspects of caring for self focused on the emic beliefs of self-care. The themes of being obligated and dedicated; distancing oneself as a reasoned action; and accepting the magnitude of the problem clearly identified the ability of grandmothers to take actions and make decisions about how to care for themselves. Leininger's three modes of care are represented in a schema of the emic view of caring for self. The schema is an illustration of the dynamic capacity of grandmothers to know and meet their own self-care demands and needs in order to care for their grandchildren. The need for increased awareness to change public policy and legislation related to the complex issues of caregiving by grandparents is addressed.