剖宫产术后袋鼠式护理对初产父亲角色适应及主观幸福感的影响

Effects of kangaroo nursing after cesarean section on paternal role adjustment and subjective well-being for first-time fathers

目的探究剖宫产术后袋鼠式护理对初产父亲角色适应及主观幸福感的影响。方法本研究为随机对照试验,连续选取2021年5月至2022年5月温州医科大学附属第一医院产科160例剖宫产分娩新生儿的初产父亲为研究对象,采用随机数字表法随机分为试验组和对照组(各80例)。对照组新生儿出生后,由护理人员对其实施产科常规护理,将新生儿置于包被中保暖送入病房,父亲在一旁照顾,对父亲给予产后常规宣教与指导1次/d,包括新生儿沐浴、抚触及脐臀部护理,产妇乳房护理,母乳喂养,饮食,用药,出院注意事项等。试验组在此基础上实施袋鼠式护理:父亲取舒适位半靠在躺椅上,解开胸口衣服,在研究人员帮助下将裸体新生儿头上脚下呈60°左右趴在父亲胸口,进行最大面积的皮肤接触,用一条毛毯盖在新生儿背部,父亲衣服包裹着新生儿,整个过程播放轻柔的音乐,鼓励父亲与新生儿进行言语交流、抚触等。新生儿返回病房后立即进行首次袋鼠式护理,之后以同样方式进行2次/d,持续30~40 min/次,于出生前3 d共完成6次护理。两组住院周期均为5 d。对入组初产父亲角色适应量表、主观幸福感量表进行评分,采用独立样本t检验比较两组新生儿出院时初产父亲角色适应水平及主观幸福感差异,采用Pearson相关性分析评估两者的相关性。结果试验组角色适应总分及角色认同情况、亲子依附建立、照护行为实施3个维度得分均显著高于对照组[(83.91±7.90)比(78.79±9.44)分、(28.94±2.64)比(27.85±3.36)分、(28.39±3.15)比(26.46±3.52)分、(26.59±4.26)比(24.48±3.81)分](t=3.725、2.276、3.647、3.309,均P<0.05);主观幸福感总分及健康的担心、精力、忧郁或愉快心境3个维度得分均显著高于对照组[(88.34±6.38)比(83.43±7.26)分、(7.70±1.77)比(6.95±1.46)分、(20.03±3.15)比(18.76±2.94)分、(19.41±2.01)比(17.99±2.68)分](t=4.546、2.928、2.625、3.805,均P<0.05),且显著高于干预前[(74.83±5.84)分、(6.11±2.22)分、(16.98±2.68)分、(15.18±2.13)分](t=13.069、5.207、6.261、13.332,均P<0.05)。初产父亲主观幸福感与角色适应水平呈正相关(r=0.614,P<0.001)。结论剖宫产术后袋鼠式护理可提高初产父亲角色适应水平及主观幸福感,且主观幸福感与角色适应水平存在正相关,角色适应越好,主观幸福感越高。

Objective To explore the effects of kangaroo nursing after cesarean section on the paternal role adaptation and subjective well-being of first-time fathers.Methods In this randomized controlled trial,a total of 160 first-time fathers of newborns delivered by cesarean section from May 2021 to May 2022 in the First Affiliated Hospital of Wenzhou Medical University were continuously selected as research objects and randomly divided into experimental group(80 cases)and control group(80 cases)by random number table method.In the control group,the nursing staff carried out routine obstetric care after the birth of the newborns,the newborns were swaddled to keep warm and transferred to the ward,the fathers took care of them by the side;and the fathers were given postnatal routine education and guidance once a day,including newborn bathing,touching and umbilical buttock care,maternal breast care,breastfeeding,diet,medication and discharge precautions etc.The experimental group were given kangaroo nursing on care basis of control group:the father took a comfortable position that half leaned on the recliner with his shirt unbuttoned,the naked newborn was placed on the father′s chest at an angle of approximately 60 degree on the head up and feet down for maximum skin to skin contact with the help of researchers.The newborn′s back was covered with a blanket and wrapped in the father′s clothes,soft music was playing throughout the whole process,meanwhile,researchers encouraged interactions through verbal communications and touching between the father and the newborn.After newborns returned to the ward,they were given kangaroo nursing immediately by the fathers for the first time,and then twice a day in the same way,lasting for 30-40 min every time,and a total of 6 times of kangaroo nursing were completed during in first 3 days after birth.The average hospitalization period of both groups was 5 days.The father-role adjustment scale and subjective well-being scale were asseessed in the fathers,the independent sample t test was used to compare differences of father-role adjustment level and subjective well-being at the time of discharge between the two groups,the Pearson correlation analysis was used to evaluate the correlation between the two variables.Results The total score of paternal role adaptation,and the three dimensions scores including role identity,parent-child attachment establishment and nursing behavior implementation in the experimental group were all significantly higher than those in the control group(83.91±7.90 vs 78.79±9.44,28.94±2.64 vs 27.85±3.36,28.39±3.15 vs 26.46±3.52,26.59±4.26 vs 24.48±3.81)(t=3.725,2.276,3.647,3.309,all P<0.05).The total score of subjective well-being,and the three dimensions scores including health worry,energy,melancholy or pleasant mood in the experimental were all significantly higher than those in the control group(88.34±6.38 vs 83.43±7.26,7.70±1.77 vs 6.95±1.46,20.03±3.15 vs 18.76±2.94,19.41±2.01 vs 17.99±2.68)(t=4.546,2.928,2.625,3.805,all P<0.05),and were all significantly higher than those before the intervention(74.83±5.84,6.11±2.22,16.98±2.68,15.18±2.13)(t=13.069,5.207,6.261,13.332,all P<0.05).There was a positive correlation between fathers′subjective well-being and paternal role adaptation(r=0.614,P<0.001).Conclusions The father-centered kangaroo nursing after cesarean section can improve postpartum paternal role adaptation and subjective well-being of first-time fathers.There is a positive correlation between the subjective well-being and the paternal role adaptation level.