پديد آورندگان :
باركزايي، فاطمه دانشگاه علوم پزشكي زاهدان - دانشكده پرستاري و مامايي , نويديان، علي دانشگاه علوم پزشكي زاهدان - دانشكده پرستاري و مامايي - مركز تحقيقات سلامت بارداري - گروه روان پرستاري , رضائي، نسرين دانشگاه علوم پزشكي زاهدان - دانشكده پرستاري و مامايي - مركز تحقيقات پرستاري جامعه - گروه روان پرستاري
كليدواژه :
افسردگي , شناختي رفتاري , مادران , نوزاد نارس
چكيده فارسي :
زمينه و هدف: با وجود پيشرفت‌هايي كه در زمينه مراقبت با كيفيت در بخش‌هاي ويژه نوزادان انجام شده است، نيازهاي رواني مادران آنها كمتر مورد توجه قرار گرفته است. مادراني كه نوزاد نارس آنها در بخش‌هاي ويژه نوزادان بستري مي‌شوند با انواعي از مشكلات روانشناختي همچون افسردگي روبه رو مي‌شوند. امروزه شناسايي و ارائه برنامه مداخله زود هنگام براي پيشگيري و كاهش اين شرايط به يكي از اولويت‌هاي خدمات بهداشتي در جهان تبديل شده است. لذا اين مطالعه با هدف تعيين تأثير برنامه آموزش شادكامي فوردايس بر افسردگي مادران نوزادان نارس بستري در بخش مراقبت‌هاي ويژه نوزادان مراكز درماني شهر زاهدان انجام شد.
روش بررسي: اين مطالعه نيمه تجربي در بهار و تابستان سال 1398 بر روي 80 مادر نوزاد نارس بستري در بخش مراقبت ويژه نوزادان در شهر زاهدان انجام شد. نمونه‌گيري به شيوه در دسترس انجام شد و نمونه‌ها در دو گروه مداخله (40 نفر) و كنترل (40 نفر) قرار گرفتند. قبل از مطالعه از مادران خواسته شد كه فرم اطلاعات فردي و پرسشنامه افسردگي بك را تكميل نمايند. مادران گروه مداخله در گروه‌هاي 5-4 نفره برنامه آموزش شادكامي فوردايس (Fordyce) را طي شش جلسه به صورت يك روز درميان در مدت زمان 60 -45 دقيقه دريافت كردند. پس از گذشت يك ماه از مداخله مجدداً پرسشنامه تكميل شد. داده‌ها به وسيله نرم افزار SPSSنسخه 16 و به كمك آزمون‌هاي آماري مورد تجزيه و تحليل قرار گرفتند.
يافته‌ها: نتايج نشان داد ميانگين نمره افسردگي مادران نوزادان نارس بستري در بخش ويژه نوزادان دو گروه پس از آموزش شادكامي فوردايس تفاوت آماري معني‌دار دارد (0001/0=P) و اين بدان معني است كه اجراي آموزش شادكامي فوردايس در گروه مداخله توانسته باعث كاهش ميانگين نمره افسردگي مادران شود. ميانگين نمره افسردگي مادران نوزادان در گروه مداخله قبل از آموزش شادكامي از 81/5 ± 72/23 به 17/3 ± 47/11 پس از آن كاهش يافت و در گروه كنترل از 58/10 ± 82/21 قبل از مداخله به 62/3 ± 90/23 پس از آن افزايش يافت.
نتيجه‌گيري كلي: نتايج مطالعه حاضر نشان داد آموزش مبتني بر شادكامي فوردايس مي‌تواند افسردگي مادران نوزادان نارس بستري در بخش مراقبت‌هاي ويژه نوزادان را كاهش دهد. بنابراين مي‌توان اين برنامه آموزشي را در كنار برنامه‌هاي خانواده محور در مراكز درماني به اجرا در آورد و ضروري است برنامه‌هايي همچون آموزش شادكامي فوردايس جهت حفظ و ارتقاء سلامت روان مادران مد نظر قرار گيرد.
چكيده لاتين :
Background & Aims: The birth of a premature and sick infant leads to a severe psychological crisis for the
parents. The birth of an infant is associated with numerous changes in the family function in terms of lifestyle,
leisure, and relations of the family members. When an infant is born in need of medical care, these changes are
intensified, and the family members experience increased mental pressure. Premature delivery and admission of
the neonate adversely affects the emotional state of the mother, and one of the psychological reactions perceived
by these mothers is the onset of depressive symptoms. Depressed mothers are faced with several challenges in
the care of an inpatient infant, which are considered a risk factor for the deterioration of their mental health and
dysfunction. Despite the advances in the quality care in neonatal intensive care units (NICUs) for infants, the
psychological needs of their mothers have received less attention. The mothers of the premature infants admitted
to NICUs experience various psychological issues (e.g., depression). These issues along with the physical
complications of childbirth cause these women not to pay attention to their physical and mental health. Today,
the identification and provision of early interventions to prevent and reduce these issues have become a priority
of healthcare services in the world. The present study aimed to assess the effect of Fordyce happiness training
on the depression of the mothers of the premature infants admitted to the NICUs of the medical centers in
Zahedan, Iran.
Materials & Methods: This quasi-experimental study was conducted in the spring and summer of 2019 on 80
mothers of the premature infants admitted to the NICUs of Zahedan. The subjects were selected via convenience
sampling and divided into two groups of intervention (n=40) and control (n=40). For sampling, the researcher
initially referred to the NICUs and identified the mothers of the admitted premature infants. After explaining the
research objectives and obtaining written consent, the mothers who met the inclusion criteria were enrolled. The
mothers of the control group were enrolled first, followed by the mothers of the intervention group in order to
prevent the transfer of information in the groups. Prior to the study, the mothers were asked to complete the
demographic information form and Beck depression inventory. The mothers of the intervention group received
Fordyce happiness training in groups of 4-5 for six sessions every other day (45-60 minutes). Fordyce happiness
training is a program designed to increase the happiness of community members, which consists of 14 cognitive
and behavioral elements. In the present study, some of the components of Fordyce happiness training that were
appropriate for the sample population were presented and discussed based on examples and experiences. One
month after the intervention, the questionnaire was completed again. The control group received no other
training than the routine educational program of the hospital, as well as the posttest simultaneous with the
intervention group. Data analysis was performed in SPSS version 16 using statistical tests.
Results: The minimum and maximum age of the mothers in the intervention and control groups was 15 and 31
years and 18 and 35 years, respectively. Most of the deliveries in the intervention group were natural (65%), and
in the control group, the mode of delivery was equal in both groups (50%). No significant differences were
observed in most of the variables between the groups, while the age of the mothers was significantly different
between the groups. The analysis of covariance was used for the confounding effect of age, and the results of the
analysis of covariance to adjust the effect of the pretest scores and age variable indicated a significant difference
in the mean score of depression in the mothers of the preterm infants admitted to the NICU between the groups after Fordyce happiness training (P=0.0001). Therefore, the implementation of Fordyce happiness training in the
intervention group could reduce the mean score of depression in the mothers. The mean score of maternal
depression in the intervention group decreased from 23.72±5.81 before the intervention to 11.47±3.17 after the
intervention. In the control group, the score increased from 21.82±10.58 before the intervention to 23.90±3.62
after the intervention. However, the results of independent t-test indicated that the mean score of maternal
depression before intervention had no significant difference between the study groups (P=0.32), while it was
considered significant after the happiness training in both the intervention and control groups (P=0.0001).
Conclusion: According to the results, Fordyce happiness training could reduce depression in the mothers of the
premature infants admitted to the NICU. Although the experience of childbirth is pleasant for the mother, giving
birth to a premature infant and the admission of the infant could be an unpleasant experience, adversely
affecting the emotional state and of the mother and giving rise to depressive symptoms. In order to maintain and
promote the mental health of mothers, in addition to the care of the premature infant in medical centers, the
health of the mother of the infant should also be considered. Fordyce happiness training could positively
influence the reduction of depression in these mothers. Fordyce happiness training is a type of cognitivebehavioral intervention, which is used to reduce depression. This intervention enables the individual to find a
more positive mindset in controlling distressing emotions and thoughts, which in turn enhances the cognition of
patients by reducing depression. The reduction of depressive symptoms improves the performance of
individuals in responsibilities and duties. The mothers who overcome their issues in this regard are able to
participate in the care of the neonate during admission. Therefore, this training program could be implemented
alongside family-oriented programs in medical centers, and it is essential to consider programs such as Fordyce
happiness training to maintain and promote maternal mental health.
