基于循证实践构建NICU早产儿以家庭为中心的护理模式

目的：基于循证实践构建新生儿重症监护室（NICU）早产儿以家庭为中心的护理模式（FCC），并评价其应用于临床实践的效果。方法：选取2016年8月至2017年3月温州医科大学附属第一医院新生儿科住院的早产儿119例作为对照组，采用传统封闭式管理模式；选取2017年4月至11月我科住院的早产儿146例作为观察组，采用FCC护理模式。通过检索文献确定最佳证据，成立FCC医疗护理小组，结合最佳证据构建FCC方案：①FCC硬件设施的配备；②医务人员培训；③家属需求调查，选择合适时机纳入父母参与FCC；④早产儿照顾者知识培训；⑤采用失效模式与效应分析（FMEA）预防医院感染发生；⑥家属护理能力评估，制定出院计划。评价2组早产儿体质量增长速度、住院天数、母乳喂养率，家属首次参与FCC与出院前的护理能力，以及开展FCC前后各8个月的医院感染发生率。结果：与对照组比，观察组体质量增长速度明显增长（P＜0.01），住院天数缩短3.12 d（P＜0.01），母乳喂养率明显提高（P＜0.01），家长护理能力有显著提升（P＜0.01）；FCC前后医院感染发生率差异无统计学意义（P＞0.05）。结论：通过构建和实施FCC，有效增进早产儿生长发育，缩短住院天数，提高母乳喂养率，提高家属护理能力，有利于出院后延续性护理。

The family-centered nursing care model for NICU preterm infants based on evidence-based practice

Objective: To construct the family-centered care (FCC) nursing model in neonatal intensive care unit (NICU) based on the best evidence-based practice, and to evaluate the effect of its application in clinical practice. Methods: A total of 119 cases of premature infants hospitalized in the NICU of the First Affiliated Hospital of Wenzhou Medical University from August 2016 to March 2017 were selected as control group. A total of 146 cases of premature infants hospitalized in our department from April to November 2017 were selected as observation group, and FCC nursing mode was adopted. Through searching literature to determine the best evidence, the FCC medical nursing team was set up, and the FCC scheme was constructed based on the best evidence: ①the FCC facilities; ②the training of medical personnel; ③the investigation of family needs and the selection of appropriate time for parents to participate in FCC; ④the training of family members of premature infants; ⑤using the failure mode and effect analysis (FMEA) to prevent nosocomial infection; ⑥an assessment of care ability of family members and the formulation of discharge plan. To compare the two groups in terms of growth rate of body mass, length of stay, breastfeeding rate, the ability of family members to participate in FCC for the first time and nursing before discharge, and the incidence of nosocomial infection before and after FCC. Results: Compared with the control group, the growth rate of body mass in the observation group increased significantly (P<0.01), hospitalization days shortened by 3.12 days (P<0.01), breastfeeding rate increased significantly (P<0.01), parental care ability improved significantly (P<0.01), and there was no significant difference (P>0.05) in the incidence of nosocomial infection before and after FCC. Conclusion: The construction andimplementation of FCC can effectively improve the growth and development of premature infants, short hospitalization days, improve breast feeding rate, and improve the care ability of family members, which improved the continuing care quality after discharge.