مراقبت خانواده محور و انتقال بين بيمارستاني نوزادان پرخطر

Family-Centered Care and the Inter-Hospital Transport of Critically Ill Neonates

ﻣﻘﺪﻣﻪ: اﻧﺘﻘﺎل اﯾﻤﻦ ﺑﯿﻦ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ ﻧﻮزاد ﭘﺮﺧﻄﺮ، ﺑﺨﺸﯽ از ﻣﺮاﻗﺒﺖ ﻫﺎي ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ اﺳﺖ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﯿﺰان ﺑﺎﻻي اﻧﺘﻘﺎل ﺑﯿﻦ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ و اﻫﻤﯿﺖ ﺣﻀﻮر ﺧﺎﻧﻮاده ﺑﻪ ﻋﻨﻮان ﻋﻨﺼﺮ اﺻﻠﯽ در ﻣﺮاﻗﺒﺖ از ﺷﯿﺮﺧﻮار )ﻣﺮاﻗﺒﺖ ﺧﺎﻧﻮاده ﻣﺤﻮر(، اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺑﺮرﺳﯽ ﻣﯿﺰان اﺟﺮاي ﻣﺮاﻗﺒﺖ ﺧﺎﻧﻮاده ﻣﺤﻮر ﺣﯿﻦ اﻧﺘﻘﺎل ﺑﯿﻦ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ ﻧﻮزادان ﭘﺮﺧﻄﺮ اﻧﺠﺎم ﺷﺪ. روش ﻫﺎ: در اﯾﻦ ﭘﮋوﻫﺶ ﺗﻮﺻﯿﻔﯽ- ﻣﻘﻄﻌﯽ، 150 ﻧﻔﺮ از واﻟﺪﯾﻦ ﻧﻮزادان ﻣﻨﺘﻘﻞ ﺷﺪه از ﺑﯿﻤﺎرﺳﺘﺎن ﻫﺎي اﺳﺘﺎن ﺑﻪ NICU) Neonatal intensive care unit( ي ﺗﻨﻬﺎ ﻣﺮﮐﺰ ﻓﻮق ﺗﺨﺼﺼﯽ ﮐﻮدﮐﺎن در ﻣﺎزﻧﺪران و 150 ﻧﻔﺮ از اﻋﻀﺎي ﺗﯿﻢ اﻧﺘﻘﺎل اﯾﻦ ﻧﻮزادان در ﺳﺎل 1397 ﺑﻪ روش ﻏﯿﺮ ﺗﺼﺎدﻓﯽ در دﺳﺘﺮس اﻧﺘﺨﺎب ﺷﺪﻧﺪ. اﻃﻼﻋﺎت ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺶ ﻧﺎﻣﻪ ي ﭘﮋوﻫﺸﮕﺮ ﺳﺎﺧﺘﻪ در ﺧﺼﻮص اﺟﺮاي اﺻﻮل ﻣﺮاﻗﺒﺖ ﺧﺎﻧﻮاده ﻣﺤﻮر 12 ﮔﻮﯾﻪ اي ﺑﺮاي واﻟﺪﯾﻦ و 8 ﮔﻮﯾﻪ اي اﻋﻀﺎي ﺗﯿﻢ اﻧﺘﻘﺎل )ﺑﺎ ﭘﺎﺳﺦ ﻫﺎي دو ﮔﺰﯾﻨﻪ اي ﺑﻠﯽ و ﺧﯿﺮ ﺑﺎ اﻣﺘﯿﺎز ﺻﻔﺮ و ﯾﮏ( ﺟﻤﻊ آوري و داده ﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓﺰار SPSS ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﮔﺮدﯾﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻣﯿﺰان اﺟﺮاي ﻣﺮاﻗﺒﺖ ﺧﺎﻧﻮاده ﻣﺤﻮر ﺣﯿﻦ اﻧﺘﻘﺎل ﻧﻮزاد از ﻧﻈﺮ 132 ﻧﻔﺮ )88 درﺻﺪ( اﻋﻀﺎي ﺗﯿﻢ اﻧﺘﻘﺎل و ﻫﻤﭽﻨﯿﻦ، از ﻣﻨﻈﺮ 100 ﻧﻔﺮ )66/7 درﺻﺪ( از واﻟﺪﯾﻦ ﻣﻄﻠﻮب ﺑﻮد ﮐﻪ اﺧﺘﻼف اﯾﻦ دو دﯾﺪﮔﺎه از ﻧﻈﺮ آﻣﺎري ﻣﻌﻨﯽدار ﺑﻮد )0/001 = P(. در ﻣﻘﺎﺑﻞ، 30 ﻧﻔﺮ )20 درﺻﺪ( از واﻟﺪﯾﻦ، 91 ﻧﻔﺮ )60/7 درﺻﺪ( از اﻋﻀﺎي ﺗﯿﻢ اﻧﺘﻘﺎل اذﻋﺎن داﺷﺘﻨﺪ ﮐﻪ اﻣﮑﺎن ﺑﺮﻗﺮاري ﺗﻤﺎس ﭘﻮﺳﺘﯽ ﺣﯿﻦ و ﻗﺒﻞ اﻧﺘﻘﺎل ﻧﻮزاد ﺑﺮاي واﻟﺪﯾﻦ وﺟﻮد داﺷﺖ ﮐﻪ اﯾﻦ ﻋﺪم ﺑﺮاﺑﺮي ﭘﺎﺳﺦﻫﺎ در ﮔﺮوه واﻟﺪﯾﻨﯽ و ﺗﯿﻢ اﻧﺘﻘﺎل ﻣﻌﻨﯽدار ﺑﻮد )0/001 = P(. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: از دﯾﺪﮔﺎه ﺑﯿﺸﺘﺮ اﻋﻀﺎي ﺗﯿﻢ اﻧﺘﻘﺎل و واﻟﺪﯾﻦ، ﻣﺮاﻗﺒﺖ ﺧﺎﻧﻮاده ﻣﺤﻮر ﺣﯿﻦ اﻧﺘﻘﺎل ﺑﯿﻦ ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ در ﺣﺪ ﻣﻄﻠﻮب اﺟﺮا ﻣﯽ ﺷﻮد، اﻣﺎ از ﻣﻨﻈﺮ ﻫﺮ دو ﮔﺮوه، ﺗﻤﺎس ﭘﻮﺳﺘﯽ واﻟﺪﯾﻦ و ﻧﻮزاد در ﺣﺪ ﻣﻄﻠﻮب ﻓﺮاﻫﻢ ﻧﻤﯽ ﮔﺮدد. از اﯾﻦ رو، آﻣﻮزش ﺑﯿﺸﺘﺮ در اﯾﻦ زﻣﯿﻨﻪ، ﺿﺮوري ﺑﻪ ﻧﻈﺮ ﻣﯽ رﺳﺪ

Background: Safe inter-hospital transfer of high-risk neonate is a part of hospital care. Due to the high rate of inter-hospital transport and the importance of family presence as a key element in infant care (family-centered care), this study aimed to determine the extent of carrying out family-centered care during the inter-facility transport of high risk neonates. Methods: In this descriptive cross-sectional study, 150 parents of neonates transferred from the hospitals of the Mazandaran Province, Iran, to neonatal intensive care unit (NICU) of the only children's subspecialty center in this province, and 150 members of the neonatal transport team were selected using non-random sampling convenient method in 2018. The data were collected using a researcher-made questionnaire about the implementation of family-centered care during the inter-facility transport with 8 questions for transport team and 12 for parents with yes or no answer, and analyzed using SPSS software. Findings: 88% of transport team members (132 case) and 66.7% of the parents (100 case) stated that family-centered care during the transport of neonates was desirable; and there was a significant difference between them (P = 0.001). In contrast, 30 parents (20%), 91 members of the transport team (60.7%) acknowledged that it was possible for the parents to make skin to skin contact during and before the transfer of the baby; the imbalance of responses in the parent group and transport team was significant, too (P = 0.001). Conclusion: Although from the viewpoint of most the members of the transport team and the parents, family-entered care during the inter-hospital transport was optimal, but both groups stated that the skin contact between the parents and the baby was not well provided; this need more education