摘要
品质圈是一种被各行各业广泛推广应用的新型的质量管理模式,它带给人们的启示是将目标管理巧妙地结合了人性管理的激励措施。母乳具有营养、防病、增进母子感情、促进产妇健康、经济卫生等优点。现在坚持4~6个月纯母乳喂养是创建爱婴医院的重要指标,但影响坚持母乳喂养的因素有很多,如分娩方式、睡眠情况、饮食情况、产妇情绪等均可直接影响泌乳量。现行的产后访视服务模式虽然在一定程度上能够解决部分产妇在出院后所遇到的一些影响母乳喂养的问题,但是随着社会的发展进步以及产妇生活水平、健康需求的不断提高,产妇对产后访视的需求及要求也随之越来越高。现行的产后访视是护理人员的一种自觉行为,缺乏管理部门的督促及检查,随着纯母乳喂养率的下降,间接反映了现行的产后访视服务模式已不能完全满足各个产妇及婴儿的需要,其内容、形式和管理方式都应有新的突破。
本研究为探讨产后访视中应用品质圈对持续性母乳喂养质量的影响,将本院产科住院200例剖宫产产妇分为实验组及对照组,每组100例,实验组在产后访视中实施品质圈活动对产妇进行母乳喂养指导,对照组按照现行产后访视模式进行母乳喂养指导,在每个产妇出院后28天,两组分别对出现乳房胀痛产妇例数、乳头皲裂产妇例数及产妇母乳喂养自信心评分进行比较分析,在每个产妇出院后120天,两组分别对纯母乳喂养率、混合喂养率及人工喂养率、产妇改变喂养方式的原因及护理人员对产妇追踪服务总次数进行比较分析,结果显示产后访视中应用品质圈这种新颖的产后访视模式,提高了护理人员访视行为的依从性,可促进产后访视的有效开展,提高了纯母乳喂养率,有效的加强了母乳喂养支持组织的建设,值得在爱婴医院推广。
Object:
Breast feeding is a sort of natural feeding mode since human beings have existed, its advantages include nutrient, immune, enhancement of sensation between mothers and infant, healthy, economy and sanitation. 4-6months breast feeding is significant guideline of infant fonding hospital. But there are many factors influencing breast feeding, such as labor mode, dormancy, diet, mood. Though active postnatal visit can partially solve some problem in breast-feeding, with development of society, standard of living and healthy demand, the management of postnatal visit is improving now. Active postnatal visit is an consciousness behavior of paramedic which is lack of administer. And the decent of breast feeding rate indirectly reflects the discomfort of active postnatal visit and the require of maternity. This research advocates using quality control circle (QCC) in postnatal visit, it is a new quality administer pattern which guide breast feeding in time and meticulously. Aim to observe QCC’s efficiency, we prove it can improve paramedic’s compliance and disposal ability so as to elevate breast-feeding rate.
Methods:
Object were maternities who undergone caesarean birth in Second Hospital of Jilin University during Jan 2009 and Apr 2009. There are experimental group and control group. Every maternity was accepted breast feeding guidance. In control group, maternities are accepted breast feeding follow-up guidance in the 14th , 28th day and 2nd month , 4th month after birth while maternities in experimental group accepted QCC guidance. According to status investigation cause analysis, strategies, implement, our member could visit in time, guide at any moment and drop in guidance if necessarily. Secretary recorded: self-confidence grade, cause of breast bulge and mammilla chap in 28th day after birth. And simple breast feeding cases, fixed feeding cases, got-up feeding cases in 120th day after birth. Result to exchange feeding pattern and total frequency of visit are undergone statistics analysis.
Results:
(1)common insistence of infant gender, weight, maternity age, pregnant age have no statistic difference (P>0.05). (2)There is notably difference between confidence grade . (3)Instance of simple breast feeding, fixed feeding, got-up feeding in the 120th day after birth have notably difference. (4) About results of exchanging feeding pattern, influence of metal factor’s exchange have notably difference. (5) After 120 days visit degree have marked difference. (6) After 28 days , ratio of cases which undergone mammilla chap, breast bulge have marked difference.
Conclusions:
(1) QCC provide ensures quality, promote development of nursing administer. (2) Using QCC in postnatal visit, paramedic members can evaluate instance of infant and can promote maternity and infant’s health. It’s benefit to descend breast bulge and mammilla chap, which can promote maternities’confidence and avoid exchange of feeding pattern. (3) QCC can fill up with paramedic requirement, promote compliance of visit, impulse development of postnatal visit, promote simple breast feeding rate, descend fixed feeding rate and got-up feeding rate, ensure the duration of breast feeding, improve the quality of breast feeding.
引文
[1]邢文英.QC小组基础教程[M].北京:中国社会出版社,2004:4.
[2]杨丽,王卫琼.参与管理模式在护理管理中的应用[J].护理管理杂志,2004, 4(4):44-45.
[3]林瑞荣.品质管理[M].厦门:厦门大学出版社,2000:146.
[4]方桂珍.在护理人员中推行品管圈活动的探讨[J] .护理研究,2008,22(4): 1103-1104.
[5]伍勇军,伍宇.QCC品质圈操作实务与案例[M].广东:广东经济出版社, 2004:3-4.
[6]王光伟.质量管理职位工作手册[M].北京:人民邮电出版社,2009:165.
[7]伍勇军,伍宇.QCC品质圈操作实务与案例[M].广东:广东经济出版社, 2004:14-15.
[8]营云川.品质圈实战12周[M].深圳:海天出版社,2003:3-5.
[9]邓少芳,邓桂芳,黄英群,等.品质圈活动在提高护理病历书写质量中的应用[J].现代护理,2006,12(24):2330.
[10]World Health Organization.Indieator for assessirg breast-feeding Praetiees:report of an informal meeting[R].Geneva witzer Land,1991:14.
[11]Martin RM, Smith GD, Mangtani P, etal.Association between breast- feeding and growth: the Boyd Orr cohort study.Arch D is Child Fetal Neonatal Ed, 2002,87: 193-201.
[12]Onayade AA, Abiona TC, Abayomi IO, etal.The first six month growth and illness of ecxlusively and non exclusively breast fed infants in Nigeria.East A fr Med J, 2004,81: 146-153.
[13]乐杰.妇产科学[M].第五版.北京:人民卫生出版社,2000:102.
[14]董福梅,祝春红,郭会平.影响剖宫产产妇母乳喂养的相关因素及护理措施[J].家庭护士,2008,6(1):206-207 .
[15]李娟,杨慎启.母婴同室对母婴的近期影响[J].中国实用妇科与产科杂志,1997,13(2):84-86.
[16]郭振清,王爱敏,池旭英,等.影响母乳喂养的原因分析与护理对策[J]齐鲁护理杂志,2005,11(8):1005-1006.
[17]刘承芝.早期母乳喂养中常见乳房问题及处理[J].中外健康文摘,2007,11:70-71
[18]王文士.感冒后乳汁突减[J].四川中医,1986,11:4.
[19]高立云,朱亚农,随延秋,等.聊城市城区854例新生儿母乳喂养调查分析[J].现代康复,1998,2(11):1244-1245.
[20]张世光,宗淑兰,吴光驰,等.八十年代产妇缺乳的危险因素及干预措施的研究[J].中国公共卫生,1993,9(3):104.
[21]李香兰,刘艳丽.护理干预对母乳喂养的影响[J].齐鲁护理杂志,2005, 11(5):437.
[22]刘菁,马福兰,姜著.母乳喂养影响因素分析.中国妇幼保健,2006,21(15):2055.
[23]赵发,刘桂芝.成功母乳喂养的几点体会[J].基层医学论坛2006,10(12):1151-1152.
[24]张传荣,张传秀,古爱军.母乳喂养早期存在的问题及护理[J].实用临床医药杂志,2005,9(2):42.
[25]Blyth R,Hons M M,Creedy D K,etal. Effect of maternal confidence on breastfeeding duration : An application of breastfeeding self-efficacy theory[J].Birth,2002,29(4):278-284.
[26]江淜,吴佩雁,黄海星等.影响4个月内婴儿纯母乳喂养的因素分析及护理[J].中国妇幼保健,2006,21(11):1565-1566
[27]刘爱东,翟凤英,赵丽云.母乳喂养的研究现状[J].国外医学卫生学分册,2004,31(4):248-252.
[28]Taveras E M,Capra A M,Braveman P A,etal. Clinician support and psychosocial risk factors associated with breatfeeding discontinuation [J].Pediatrics,2003,112(l):108-115.
[29]朱丽萍.影响母乳喂养的因素[J].中国实用妇科和产科杂志,1997,13(2):70.
[30]戴晓娜,Cindy-Lee Dennis,陈叙,等.母乳喂养自信心量表在护理实践中的应用[J].中华护理杂志,2004,39(6):407-409.
[31]Garcia Casanova M,Garcia Casanova S,Juan MP,etal.Breast-feeding can health staff positively affect its duration[J].Aten Primaria.2005,35(6):295-300.
[32]李运璧,李兰,彭幼辉.职业女性乳母的信心和态度对纯母乳喂养的影响[J].中国妇幼保健,2003,18(4):206.
[33]Cindy-Lee Dennis, Sandra Faux. Development and psychometric testing of the Breastfeeding Self-Efficacy Scale. Research in Nursing and Health, 1999, 22(5):339-409.
[34]Bandura,A.Self-efficacy-the Exercise of control.W.H.freeman and Company,1997.
[35]王廷主编.当代心理学研究[M].北京大学出版社,1993.
[36]Murphy,C.A.,&Kraft,L.A.Development and validation of the perinatal nursing self-efficacy seale. Seholarly Inquiry for Nursing Practice:An International Journal,1993:7,95-105.
[37]万九菊,汪中华.产后访视及护理体会[J].CHINESE GENERAL NURSING,2008,6(12):3232.
[38]王芳,徐海青,孟璞,等.湖北省4—6个月婴儿母乳喂养状况及影响因素[J].中国妇幼保健,2000,15(10):624-626.
[39]朱丽萍,杨文尉,周冰华.上海市4个月内纯母乳喂养现状调查[J].中国妇幼保健,1996,11(2):47.
[40]许瑞清,岑绮玲,冯玉珍.产后访视现场指导提高母乳喂养率体会[J].国际医药卫生导报,2006,12.(2):117-119.
[41]Baron-EpelO,DushenatM., Friedman N. Evaluation of the customer mode:l Relationship between patients, expectation, perception and satisfation with care[J]. International Journal for Quality in Health Care,2001,13(4): 317.
[42]赵耀,黄磊,张正,等.2002年北京市2岁以内婴幼儿营养与喂养状况调查[J].中华预防医学杂志.2006,4(1):46-49.
[43]刘一心,黄荣彬,江海萍,等.深圳市母乳喂养现状及对儿童生长发育的影响[J].中国儿童保健杂志,2006,14(6):574-576.
[44]王晓燕,彭晶,漆小凤.产后访视的应用价值和发展策略[J].井冈山学院学报(自然科学),2008,29(10):120-124.
[45]中华人民共和国卫生部妇幼卫生司主编.母乳喂养培训教材.北京市新闻出版局,1992.
[46]梁海滨.品质圈管理在护士正确执行用药医嘱中的应用[J].南方护理学报,2004,11(12):59-60.
[47]陈秋芳,刘沛珍.QC小组活动在提高术前健康教育效果中的应用[J].护士进修杂志,2000,15(9):702-703.
[48]黄守春,黎艳.品质圈活动在提高烧伤病人护理服务满意度中的应用[J].中国实用护理杂志,2004,20(15):64-65.
[49]谢文,周风禅,郑志惠,等.品质圈活动在护理质量管理中的作用[J].护士进修杂志1999,14(12):15-16.
[50]李旺君,王利香.“品管圈”活动在护士长夜查房中的应用与效果[J].护理管理杂志2007,7(5):55-56.
[51]程洁.品质圈活动在ICU仪器管理中的应用[J].护理与康复2007,6(6):413-414.
[52]黄守春,黄连英,李财芝,等.品质圈活动在规范病区物品管理中的应用[J].现代护理2007,13(33):3235-3236.
[53]綦艳琳,李海燕,陶昊.品质管理圈在创伤外科护理中的应用[J].济宁医学院学报,2009,32(3):216.
[54]李峰.护理环节质量控制方法探讨[J].中国医院管理,2006,26(6):54.
[55]张文坤,郝波,王临虹.中国部分城市社区婴幼儿母乳喂养状况调查[J].中国健康教育,2004,20(l):14-16.
[56]刘素娥.产妇产后健康教育方法研究[J].护士进修杂志,2005,11.
[57]王晓莉.妇女产褥期特殊行为[J].中国妇幼保健,2005,3(20):374-375.
[58]王淑梅.产后访视是母婴身心健康的保障[J].中外医疗2009,(9):164.
[59]母乳喂养培训教材.中华人民共和国卫生部妇幼卫生司,92:3.
[60]Van den Wijden C,K leijnen J,Van den Berk T. Lactational am enorrhea forfamily planning[J]. Cochrane Database SystRev, 2003,(4):1329.
[61]彭淑梅,曾静,陈以荣.社区产后访视对母婴健康水平的影响[J].实用全科医学,2007,5(3):245-246.
[62]郑修霞.妇产科护理学[M].2版.北京:人民卫生出版社,1999:143-144.
[63]林菊英,金乔.中华护理全书[M].南昌:江西科学技术出版社,1993:1971-1972.
[64]应莲琴,王赛君,陈雪英.质控员在护理质量持续改进中的作用[J].护理研究,2006,20(2A):355.
[65]潘孟昭.护理学导论[M].北京:人民卫生出版社,1999:3-4.
[66]李小妹.护理学导论[M].第2版.北京:人民卫生出版社,2007:43-44.
[67]刘月璋,张蔼丽,郝波,等.北京市母婴同室婴儿母乳喂养情况追访结果分析[J].中国妇幼保健,1993,8(5):25.
[68]徐韬,于晓松.提高孕产妇母乳喂养率的干预模式研究[J].中国医科大学学报,2009,38(4):309-311.
[69]Jones DA,West RR,Effect of a lactation nurse on the success of breastfeeding a random ized Controld triol.JE-pidemiol Community Health,1986,40:45.
[70]全小珍,杨海虹,郑秀红.影响母乳喂养的相关因素探讨[J].中国妇幼保健,2005,20(11):1305-1306.
[71]郭振清,王爱敏,池旭英,等.影响母乳喂养的原因分析及护理对策[J].齐鲁护理杂志,2005,11(8):1005-1006.
[72]张丽芳.母乳喂养失败114例的原因分析及对策[J].现代中西医结合杂志,2007,9,16(26):3830-3831.
[73]潘迎,武明辉,杨美英,等.产后保健质量评估与需求研究[J].中国妇幼保健,2001,16(2):89-92.