贵州省黔西南州新生儿重症监护病房医生和护士母乳喂养知识、态度、实践现状调查

Survey on the knowledge,attitude,and practices of breastfeeding among doctors and nurses in the neonatal intensive care unit of Qianxinan Prefecture,Guizhou Province

目的了解贵州省黔西南州新生儿重症监护病房(neonatal intensive care unit,NICU)母乳喂养情况及医生和护士母乳喂养知识、态度、实践现状,为母乳喂养质量改进提供基础资料。方法编制NICU母乳喂养知识、态度、实践调查问卷,问卷分为知识、态度和实践3个维度,分别有7(总分7分)、9(总分45分)和7个条目(总分35分),得分越低表示母乳喂养认识越薄弱;并设置最影响母乳喂养因素的5个条目。于2023年11月25日至30日对贵州省黔西南州9家医院新生儿科的有执业资格证书且在本科室工作满1年的医生和护士开展调查。采用两独立样本t检验和χ^(2)检验比较不同级别医院、同级别医院医生和护士在NICU母乳喂养知识、态度、实践维度的得分情况。结果(1)9家医院中3家为三级甲等(简称三甲)医院,实际纳入调查的医生占医生总数的95.6%(43/45),护士占护士总数的96.5%(110/114);6家二级甲等(简称二甲)医院,实际纳入调查的医生占医生总数的95.0%(38/40),护士占护士总数的97.6%(83/85)。(2)9家单位均为爱婴医院,院内均有母乳喂养宣传资料,其中6家医院NICU开展母乳喂养,全州2021年至2023年NICU母乳喂养率平均为25.8%。(3)同级别医院内,医生参加过母乳喂养培训的比例均高于护士[三甲医院:69.8%(30/43)与40.0%(44/110),χ^(2)=10.97,P=0.001;二甲医院:47.4%(18/38)与24.1%(20/83),χ^(2)=6.55,P=0.010],但比例均较低。(4)三甲医院中,医生态度维度总分高于护士[(35.35±4.75)与(33.18±5.60)分,t=-2.03,P=0.044]、实践维度总分也高于护士[(26.98±3.00)与(25.60±3.75)分,t=-2.17,P=0.032];二甲医院中,医生知识维度总分高于护士[(4.92±1.44)与(4.20±1.45)分,t=-2.52,P=0.013]。三甲医院医生态度及实践维度总分均高于二甲医院医生,三甲医院护士知识、态度及实践维度总分均高于二甲医院护士(P值均<0.05)。(5)知识维度中,三甲医院医生得分最低的条目为“母亲乙型肝炎新生儿生后接种疫苗和免疫球蛋白后可母乳喂养”,三甲医院护士以及二甲医院医生和护士得分最低的条目为“母乳喂养持续时间长短对新生儿结局影响更大”;态度维度中,三甲和二甲医院医生和护士得分最低的条目均为“您认为母乳喂养流程比早产儿配方奶喂养麻烦”;实践维度中,三甲医院医生和护士得分最低的条目均为“您院有足够的母乳喂养知识培训”,二甲医院医生和护士得分最低的条目分别为“您有更多机会能参加各种母乳喂养相关培训”,以及“患儿生后积极救治稳定后,应该尽早开始母乳喂养”。(6)最影响母乳喂养因素依次为患儿父母不配合母乳喂养(50.0%,137/274)、医生和护士人力资源相对不足(21.9%,60/274)以及母乳喂养管理制度没有制定或落实(18.3%,50/274)等。结论本地区县市级医院NICU母乳喂养率偏低,医护人员对母乳喂养认识相对不足,尤其是护士。应加强医护人员母乳喂养各项培训,提高对NICU母乳喂养的认识。

Objective To understand the breastfeeding situation in the neonatal intensive care units(NICUs)in Qianxinan Prefecture,Guizhou Province,and to assess the knowledge,attitudes,and practices of doctors and nurses regarding breastfeeding,aiming to provide foundational data for improving breastfeeding quality.Methods A questionnaire was developed to survey the knowledge,attitudes,and practices related to breastfeeding in NICUs.The questionnaire was divided into three dimensions:knowledge(seven items,total score of 7),attitudes(nine items,total score of 45),and practices(seven items,total score of 35).Lower scores indicated weaker recognition of breastfeeding.Additionally,five items were included to identify the most influential factors affecting breastfeeding.From November 25 to November 30,2023,a survey was conducted among doctors and nurses with professional qualifications who had worked in the neonatal departments of nine hospitals in Qianxinan Prefecture for at least one year.Independent sample t-tests and Chi-square tests were used to compare the scores of doctors and nurses from different levels of hospitals and within the same level of hospitals across the three dimensions.Results(1)Among the nine hospitals,three were tertiary grade A hospitals(referred to as"tertiary hospitals"),with 95.6%(43/45)of the doctors and 96.5%(110/114)of the nurses participating in the survey.Six were secondary grade A hospitals(referred to as"secondary hospitals"),with 95.0%(38/40)of the doctors and 97.6%(83/85)of the nurses participating.(2)All nine hospitals were baby-friendly hospitals and all had breastfeeding promotional materials.Six hospitals had NICUs that promoted breastfeeding,with an average NICU breastfeeding rate of 25.8%across the prefecture between year 2021 to 2023.(3)The proportion of doctors who had received breastfeeding training was higher than that of nurses within the same level of hospitals[tertiary hospitals:69.8%(30/43)vs.40.0%(44/110),χ^(2)=10.97,P=0.001;secondary hospitals:47.4%(18/38)vs.24.1%(20/83),χ^(2)=6.55,P=0.010],although the overall training rates were low.(4)In tertiary hospitals,doctors scored higher than nurses in the attitude dimension[(35.35±4.75)vs.(33.18±5.60)scores,t=-2.03,P=0.044]and also in the practice dimension[(26.98±3.00)vs.(25.60±3.75)scores,t=-2.17,P=0.032].In secondary hospitals,the total knowledge dimension score of doctors was higher than that of nurses[(4.92±1.44)vs.(4.20±1.45)scores,t=-2.52,P=0.013].In tertiary hospitals,the total scores for attitude and practice dimensions of doctors were higher than those of doctors in secondary hospitals,and the total scores for knowledge,attitude,and practice dimensions of nurses were higher than those of nurses in secondary hospitals(all P<0.05).(5)In the knowledge dimension,the lowest scoring item of doctors in the tertiary hospitals was"Breastfeeding is possible for maternal hepatitis B newborns after receiving vaccines and immunoglobulin";the lowest scoring item of nurses in the tertiary hospital,and doctors and nurses in the secondary hospitals was"The duration of breastfeeding has a greater impact on neonatal outcomes".In the attitude dimension,the lowest scoring item for doctors and nurses in both tertiary and secondary hospitals was"You think the breastfeeding process is more troublesome than feeding preterm formula".In the practice dimension,the lowest scoring item of the doctors and nurses in the tertiary hospitals was"Your hospital had enough breastfeeding knowledge training",while for the doctors and nurses in the secondary hospitals were"You have more opportunities to participate in various breastfeeding-related training"and"Breast feeding should be started as soon as possible when the infant is stable after active treatment",respectively.(6)The most influential factors affecting breastfeeding were:lack of cooperation from parents(50.0%,137/274),relative insufficient human resources for doctors and nurses(21.9%,60/274),and the absence or poor implementation of breastfeeding management policies(18.3%,50/274),etc.Conclusions The breastfeeding rate in NICU of county-level hospitals is relatively low,and medical staff,especially nurses,have insufficient knowledge about breastfeeding.It is necessary to strengthen various breastfeeding training for medical staff to enhance their understanding of NICU breastfeeding.