初产妇产后母乳喂养联合母婴床旁护理对产后康复的作用

目的 探讨初产妇产后母乳喂养采用母婴床旁护理对产后康复的作用.方法 选择2019年2月—2020年2月时段在我院分娩后的100例初产妇,根据随机数字表法分为观察组和对照组,观察组50例,对照组50例,观察组实施母婴床旁护理,对照组实施常规护理.比较两组产妇产后的母乳喂养情况、康复情况和抑郁情况.结果 观察组母乳喂养率显著高于对照组(P<0.05),观察组子宫复旧不全、盆底肌松弛导致阴道或膀胱膨出、尿潴留等产后发生率显著低于对照组(P<0.05),产后抑郁发生率显著低于对照组(P<0.05).结论 对初产妇实施产后母乳喂养和母婴床旁护理,具有良好效果,能够有效改善产后母乳喂养情况,提高康复效果,减少产妇抑郁发生,值得临床推广.     

Quality of care for residents dying in Ontario long-term care facilities: findings from a survey of directors of care

The purpose of this study was to collect information on the practice of end-of-life (EOL) care in long-term care (LTC) facilities in the Province of Ontario, Canada. A cross-sectional survey of directors of care in all licensed LTC facilities in the province was conducted between September 2003 and April 2004. Directors of care from 426 (76% response rate) facilities completed the postal survey questionnaire. The survey results identified communication problems between service providers and families, inadequate staffing levels to provide quality care to dying residents, and the need for training to improve staff skills in providing EOL care. Directors of care endorsed the use of a number of strategies that would improve the care of dying residents. Logistic regression analysis identified the eight most important items predictive of facility staff having the ability to provide quality EOL care. The findings contribute to the current discussion on policies for meeting the care needs of residents in LTC facilities until life's end.     

母婴居家护理需求现况调查分析

目的:调查分析产妇出院后居家护理的需求现况。方法:对1002例产妇进行调查,对其中有居家护理需求的330例产妇发放调查问卷。结果:在居家护理的服务模式方面,40.61%的产妇希望通过电话获得帮助;33.33%的产妇希望通过网络得到帮助;19.39%的产妇希望护理人员上门服务;6.67%的产妇希望通过短信、健康宣教单等其他方式得到问题的答案。产妇及新生儿护理方面存在多种需求。结论:产妇出院后有居家护理服务需求,服务模式及服务内容存在多样化需求。     

The infant of the diabetic mother. Pathophysiology and management

Fetal complications such as macrosomia, hypoglycemia, respiratory distress, and congenital anomalies are associated with the diabetic pregnancy. However, strict control of maternal glucose during pregnancy, labor, and delivery has been shown to favorably influence the perinatal outcome.     

母婴分离产妇泌乳行超早期乳房护理的效果观察

目的:探究母婴分离产妇泌乳期行超早期乳房护理的效果及意义.方法:择取2019年2月至2020年2月在本院分娩的母婴分离产妇共90例,根据随机数字表法进行分组,其中对照组45例,观察组45例.对照组产妇行常规护理,观察组产妇行超早期乳房护理,比较两组产妇泌乳开始时间、产后不同时间泌乳量和血清泌乳素水平,对两组产妇乳房胀痛...     

The Ontario College of Occupational Therapists: a survey.

A survey was conducted to examine how familiar Ontario occupational therapists are with the Ontario College of Occupational Therapists (OCOT), and to identify their attitudes concerning self-regulation. A questionnaire was mailed to 100 occupational therapists, 50 non-members and 50 members of the OCOT. Sixty-four (64%) occupational therapists comprised the final sample; 30 members and 34 non-members. The prototypical member is over the age of 30 years, has worked more than ten years, and has graduated from a diploma program in occupational therapy. The prototypical non-member has worked for less than five years, has graduated from a degree program in occupational therapy, and is under the age of 30 years. The results indicated that: (1) both members and non-members work full-time in a hospital setting in the area of adult physical medicine as staff therapists; and (2) are involved in their professional associations, i.e., the Ontario Society of Occupational Therapists (OSOT) and the Canadian Association of Occupational Therapists (C.A.O.T.). Both groups support the concept of a self-regulatory body, however they view its purpose quite differently. The study further suggested that the majority of occupational therapists surveyed are not aware of the many issues surrounding regulation, i.e., provisions asked for by the OCOT under the Health Disciplines Act. The results are discussed with their implications for the OCOT and for Ontario occupational therapists.     

Parental division of infant care: contextual influences and infant characteristics.

The purpose of this study was to explore the relationship of maternal employment to division of parental infant caregiving and whether infant characteristics predicted maternal and paternal caregiving during the first year. Subjects were 351 families with healthy infants from normal pregnancies. Measures included a newborn and 1-month Brazelton Neonatal Behavioral Assessment, Child Care Activities Scale at 1, 6, and 12 months, Bates Infant Characteristics Questionnaire at 6 and 12 months, and selected demographics. Mothers provided the majority of infant care though fathers' proportion increased with employment of mothers. Controlling for demographics, infant characteristics were infrequent predictors of maternal caregiving and predicted a small amount of paternal caregiving variance.     

Discharge planning and follow-up care: the asphyxiated infant.

Discharge planning and follow-up care of the asphyxiated infant is a complex process. Models of discharge planning, team member responsibilities, and teaching responsibilities are components of hospital discharge plans. Special care needs of these infants may include vision, hearing, immunizations, seizures, medications, and feeding. Families and health care professionals need to be familiar with programs providing financial resources for care of the infant such as private insurance, prepaid health care, Medicaid, Medical Needy program, Children with Special Health Care Needs (CSHCN), federal legislation mandating education and services for high-risk infants (PL 99-142 and PL 99-457) and intervention programs. Families returning to Newborn Follow-up programs become acquainted with a variety of professionals and types of neonatal and infant assessments. Providing teaching materials and information regarding special health problems, services and outcome, as it becomes known, is the responsibility of the extended health care team of nurses, physicians, home health services, psychologists, and therapists.     

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

ContextNurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting.ObjectivesTo examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge.Design and settingCross sectional analysis combining nurse survey data with infant discharge data.ParticipantsA national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997).MethodsSequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support).ResultsThe majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001).ConclusionsNeonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.     

A survey examining nurses' knowledge of pain control.

Three hundred and eighteen (318) nursing staff members at an acute care teaching hospital in Montreal, Canada, were surveyed to identify their knowledge of pain assessment and management. Two pain instruments were combined and adapted for use. The final instrument consisted primarily of true/false responses and took about 10 min to complete. The mean score was 63.9%. Overall results indicated that nurses lacked knowledge and understanding of opioid addiction, equivalent dosing, properties of opioids, and differences in acute and chronic pain. No statistically significant differences were found in the scores by level of educational preparation or by years of experience. Presentation of the results unit by unit demonstrated that the instrument is suitable as an educational tool as well as an effective strategy to introduce nursing staff to nursing research.     

Cost and quality: evidence from Ontario long term care hospitals

BACKGROUND: Although both quality and cost are important concerns for long term care (LTC) facility management and policy, the relationship between cost and quality is poorly understood. Such knowledge is necessary to guide facility management and policy action. OBJECTIVE: We sought to determine the net effect of quality on cost in LTC hospital settings. STUDY SAMPLE: A 4-year panel dataset from April 1997 through March 2002 comprising observations from 99 LTC hospitals were included in this analysis. METHODS: We examined the relationship between direct resident costs and 7 indicators of quality for long-stay residents. We used panel data methods to control for unobserved facility-level characteristics. RESULTS: We found that increases in restraint use and incident pressure/skin ulcers were associated with lower per diem costs, whereas incontinence prevalence was associated with higher per diem costs. CONCLUSIONS: Our results point to different implications regarding cost and quality for different quality indicators. Although facilities have a strong internal business case to improve quality in incontinence, policy-makers may need to provide financial incentives to encourage reductions in restraint use and incident skin ulcers so as to defray potential higher costs associated with improving quality in these areas.