HAPA理论指导下护理干预对初产妇心理健康水平、分娩自我效能感及新生儿结局的影响

Effect of HAPA theory-guided nursing intervention on the level of maternal mental health,self-efficacy for delivery,and neonatal outcome in primiparas

目的探讨健康行动过程取向(HAPA)理论指导下护理干预对初产妇心理健康水平、分娩自我效能感及新生儿结局的干预效果。方法选取2019年1月值2021年1月宝鸡市人民医院收治的124例初产妇为研究对象,按随机数表法分为对照组和观察组各62例。对照组初产妇采取常规护理,观察组初产妇在对照组基础上采取HAPA理论指导下护理,干预至产后48 h。比较两组分娩前后初产妇的心理健康水平[正性负性情绪量表(PANAS)]、分娩自我效能感[简化版分娩自我效能量表(CBSEI-C32)]、育儿胜任感[育儿胜任感量表(C-PSOC)]、分娩应对[分娩应对量表(CCB)]、主观幸福感[总体幸福感量表(GWBS)]、产后泌乳功能(泌乳始动时间、产后24 h泌乳量、产后48 h母乳喂养率)以及产妇和新生儿结局。结果观察组初产妇的正性情绪、结果期望和自我效能期望分别为(26.68±5.51)分、(132.28±12.26)分、(130.52±11.91)分,明显高于对照组的(24.43±4.69)分、(103.31±11.55)分、(99.58±9.42)分,差异均有统计学意义(P<0.05);分娩后,观察组初产妇的CCB评分、C-PSOC评分分别为(56.77±5.61)分(71.13±5.52)分,明显高于对照组的(48.120±5.53)分、(65.51±4.93)分,GWBS量表中的各项评分也明显高于对照组,差异均有统计学意义(P<0.05);观察组初产妇泌乳始动时间明显短于对照组,产后24 h泌乳量明显大于对照组,产后48 h母乳喂养率明显高于对照组,差异均有统计学意义(P<0.05);观察组初产妇的剖宫产率、产褥感染率、胎儿宫内窘迫率、早产率分别为11.29%、1.61%、1.61%、9.68%,明显低于对照组的25.81%、14.52%、16.13%、30.65%,差异均有统计学意义(P<0.05)。结论HAPA理论指导下护理干预应用于初产妇,可提高初产妇的心理健康水平,增强分娩自我效能感,促进泌乳,改善产妇及新生儿结局。

Objective To investigate the effects of Health Action Process Orientation(HAPA)theory-guided nursing intervention on the level of maternal mental health,self-efficacy for delivery,and neonatal outcomes in primiparas.Methods One hundred and twenty-four primiparous women admitted to Baoji People's Hospital from January 2019 to January 2021 were selected and divided into the control group and the observation group according to the random number table method,each with 62 patients.The women in the control group received routine care,and those in the observation group received HAPA theory-guided nursing intervention on the basis of the control group,until 48 h after delivery.The mental health level[The Positive and Negative Affect Scale(PANAS)],self-efficacy for delivery[Simplified Birth Self-Efficacy Scale(CBSEI-C32)],parenting competence[Parenting Sence of Competence Scale(C-PSOC)],coping with childbirth[Childbirth Coping Behavior Scale(CCB)],subjective well-being[General Well-Being Scale(GWBS)],postpartum lactation function(time to lactation initiation,24 h postpartum lactation,48 h postpartum breastfeeding rate),and maternal and neonatal outcomes were compared between the two groups before and after delivery.Results The positive affect,outcome expectancy,and self-efficacy expectancy of primiparous women in the observation group were(26.68±5.51)points,(132.28±12.26)points,and(130.52±11.91)points,respectively,which were significantly higher than(24.43±4.69)points,(103.31±11.55)points,and(99.58±9.42)points of the control group(P<0.05).After delivery,the CCB score and C-PSOC score of primiparous women in the observation group were(56.77±5.61)points and(71.13±5.52)points,respectively,which were significantly higher than(48.120±5.53)points and(65.51±4.93)points of the control group,and the scores in the GWBS scale in the observation group were also significantly higher than those of the control group,with statistically significant differences(P<0.05).The time of lactation initiation in the observation group was significantly shorter than that in the control group,the lactation volume at 24 h postpartum was significantly greater than that in the control group,and the breastfeeding rate at 48 h postpartum was significantly higher than that in the control group,with statistically significant differences(P<0.05).The rates of cesarean section,puerperal infection,intrauterine distress,and preterm delivery in the observation group were 11.29%,1.61%,1.61%,and 9.68%,respectively,which were significantly lower than 25.81%,14.52%,16.13%,and 30.65%in the control group(P<0.05).Conclusion HAPA theory-guided nursing intervention applied to primiparous women can improve their psychological well-being,enhance self-efficacy for delivery,promote lactation,and improve maternal and neonatal outcomes.