極低出生体重児の母子関係と看護援助 <原著>

本研究はNICUに入院中の極低出生体重児の母子関係の傾向をとらえ,行われた看護援助について検討することを目的とした.第1回調査の対象は,静岡県内のA総合病院NICUを退院した極低出生体重児と母親9事例およびプライマリーナース9名で,後方視的に半構成インタビューによりデータ収集し,内容を分析した.第2回調査の対象は静岡県内のA,B2つの総合病院NICUに入院中の極低出生体重児と母親12事例で,前方祝的に観察記録用紙を用いてデータ収集し,内容を分析した.この結果,以下のことが明らかになった.1.母親の感情・言動と児へのかかわりは5つのステージに分かれ,修正在胎週数およそ30週前後とおよそ34週以降に2つの転換の時期が認められた.2.各ステージの特徴と必要な看護援助は,ステージI:児をイメージする初回面会前までの時期(母親の心身回復への援助),ステージII:恐れの強い時期(母親の恐れの感情に特に配慮した援助),ステージIII:主体的かかわりの芽生えの時期(母親の育児行為の広がりを支える援助),ステージIV:主体的かかわり・母子相互作用の芽生えの時期(母親の主体的な育児行為を尊重した援助),ステージV:母子相互作用の安定の時期(退院に向けての情報提供と新たな不安の受止)であった.3.全ステージに共通する看護援助は,母親の気持ちに添ってタイミングを計った援助,予期的・予測的な児に関する情報提供,受容的態度を具体的に表す看護婦からの言葉かけであった.

The purpose was to find the pattern of the relationship between mothers and VLBW (very low birth weight ) infants who are hospitalized in NICU and to describe the nursing care given to them. The first study included nine mother-VLBW infant pairs and nine primary nurses. Each infant and mother had already been discharged when surveyed. The retrospective data was collected by semi-structured interviews. The second study included twelve mother-infant pairs ,where the VLBW infant was hospitalized. The progressive data was collected by documenting information on observation forms. The results were as follows: 1. The mother's emotions and behaviors towards the infant go through five stages. The relationship undergoes two positive changes: they occur around the 30th and 34th gestational week of age. 2. The characteristics of each stage and the necessary nursing care. Stage I. Before the mother is able to meet the infant for the first time, she develops an image of her child. (Care and support for the mother's emotional and physical recovery is needed.) Stage II. The mother experiences a strong fear. (Support for these fears in particular must be given. ) Stage III. The mother grows to communicate with her infant independently. (Support of the expansion of the mother's infant care.) Stage IV. The mother develops an independent relationship with her infant and mother-infant interaction begins. (Support and respect for the mother's independent care of her infant.) Stage V. The mother-infant bond is strong. (Support by giving information to the mother before being discharged to ease anxieties.) 3. The nursing care at every stage has three things in common: appropriate and timely support, which considers the mother's feeling's. Information about the expected and predicted future of the infant. Open communication with the mother in full acceptance of her fears and emotions.