ABSTRACT
Objective:To explore the intervention effect of nursing guided by self-efficacy theory on postpartum breastfeeding of patients with gestational diabetes mellitus.Methods:A total of 140 patients with gestational diabetes mellitus in Qingdao Women and Children ′s Hospital were selected as study subjects by convenient sampling method. They were divided into two groups according to the time of diagnosis. Seventy patients recruited from August to September 2019 were named as the control group, while those 70 patients from May to June 2020 were set as the intervention group. The control group took routine care and the intervention group received breastfeeding intervention based on self-efficacy theory. The rate of delayed onset of lactogenesisⅡ(DOLⅡ), breastfeeding knowledge, exclusive breastfeeding rate and breastfeeding self-efficacy in different time were compared. Results:The rate of DOLⅡ in the intervention group was 11.43% (8/70), which was lower than 25.71% (18/70) in the control group, the difference was statistically significant ( χ2=4.72, P<0.05). The score of breastfeeding knowledge in the intervention group at postpartum day 3 was 16.0 (15.0, 17.0) , which was higher than that in the control group 14.0(13.0, 16.0), the difference was statistically significant ( Z=-3.55, P<0.05). The rates of exclusive breastfeeding at postpartum day 3, month 1 and month 3 was 78.57% (55/70), 68.57% (48/70), 61.43% (43/70) in the intervention group and 61.43% (43/70), 45.71% (32/70), 37.14% (26/70) in the control group, the differences were statistically significant ( χ2=4.90, 6.60, 8.26, all P<0.05). The total scores of breastfeeding self-efficacy before intervention, 3 days, 1 month and 3 months postpartum were (48.34 ± 5.37), (50.00 ± 6.06), (52.54 ± 5.41), (52.92 ± 5.62) points in the control group and (48.96 ± 4.30), (53.32 ± 5.94), (56.91 ± 5.03), (59.11 ± 4.70) points in the intervention group. The total score of breastfeeding self-efficacy of patients in the two groups was analyzed by repeated measures of variance, and the differences in time effect, between-group effect and interaction effect were statistically significant ( Ftime=81.61, Fbetween-group=31.31, Finteraction=10.23, all P<0.05). Conclusions:Breastfeeding nursing intervention based on self-efficacy theory can improve the knowledge level of breastfeeding in patients with gestational diabetes mellitus, reduce the rate of DOLⅡ, enhance the sense of self-efficacy of breastfeeding and promote exclusive breastfeeding.
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Objective:To investigate the status and their relationship of new nurses ′ transition shock, spiritual climate and nurses ′ intention to stay on the job, to explore the mediating effect of transition shock between spiritual climate and intention to stay among newly graduated nurses. Methods:A convenient sampling method was used from October to December in 2019 to investigate 231 new graduate nurses from four hospitals in Qingdao City with the general data questionnaire, the New Nurses ′ Transition Shock Scale, the Nurses ′ Intention to Stay on the Job Scale and the Spiritual Climate Scale. Results:The total score of new nurse retention intend was (20.65 ± 4.30) points, spiritual climate score was (63.20 ± 19.28), and transition shock score was (82.92 ± 22.33) points. Transition shock was negatively correlated with spiritual climate and intention to stay ( r values were -0.451, -0.548, P<0.01) ; spiritual climate was positively correlated with intention to stay ( r value was 0.450, P<0.01). Transition shock played a partial mediating role in spiritual climate and intention to stay (37%). Conclusions:Spiritual climate of the work environment can directly or indirectly affect the intention to stay through the transition shock among newly graduate nruses. Managers can take appropriate intervention measures to improve the spirit climate of the department, alleviate the impact of new nurses ′ transformation and stabilize nursing team.
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Objective:To construct an early warning score model for the identification of hand-foot-mouth disease (HFMD) in children using the decision tree, and to provide scientific evidence for early recognition of critical HFMD in clinical practice.Methods:The medical records of 2 488 children with severe and critical HFMD hospi-talized in Qingdao Women and Children′s Hospital from January 2014 to December 2016 were retrospectively analyzed.Multivariate Logistic regression analysis was made to screen the independent risk factors of critical HFMD.An early warning score model for identifying children with HFMD was established by using the chi- square automatic interactive detection method in the decision tree, and the effectiveness of the model was evaluated by the receiver operating characteristic curve (ROC). Results:The multivariate Logistic regression analysis identified 5 independent risk factors of critical HFMD, including age<3 years old, blood sugar≥8.0 mmol/L, body temperature≥39.0 ℃, limb shaking and trembling, and hand-foot herpes.Two risk factors, i.e., blood sugar and body temperature, were included in the tree chart through the decision tree, and scoring criteria were established according to the tree chart.Combining the early warning scoring system for children, the warning model were finally set up, which consisted of 5 dimensions and inclu-ded 9 evaluation indicators: consciousness, skin color, heart rate, capillary refill time, respiratory frequency, participation of respiratory muscles, oxygen therapy, blood sugar and body temperature.Each dimension ranged from 0 to 3 points, totaling 0-15 points.The area under the ROC, sensitivity, specificity, maximum Youden index, and cut-off value of the model were 0.911, 0.910, 0.774, 0.684, and 6.5, respectively. Conclusions:The early warning score model established in this paper can accurately identify critical HFMD, with high sensitivity and specificity.
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Objective To develop an indicator system for the ability of main caregivers of premature in Neonatal Intensive Care Unit (NICU). Methods Delphi method was used to design index system and 16 experts were invited to participate the study. The questionnaire was consulted by emails and we took two rounds of consultation. Results The two rounds of consulting experts enthusiasm coefficients was 100% and the overall authority coefficients was 0.813 and 0.819. In the evaluation index system, there were 8 first grade indexes and 42 second grade indexes, including 11 items of basic care ability , 6 items of feeding and nutrition, 5 items of early itervention, 8 items of common symptoms and sign, 1 item of emergency, 5 items of safety prevention, 4 items of special care and 2 items of parentage. Conclusions The ability of main caregivers of premature in NICU evaluation index system which is designed using Delphi method is scientific and reliable. The results would have important significance to evaluate the level of main caregivers of premature in NICU.
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Objective To explore the successful breastfeeding experience of primiparous women with natural childbirth during the first 6 months postpartum. Methods A phenomenological methodology was used. Semi-structured in depth interviews were conducted among 11 primiparous women of natural childbirth. The data were transcribed, collated, summarized and analyzed using Colaizzi′s method. Results The primiparous women who sustained exclusive breastfeeding for six months after natural delivery experienced three stages which were:anxiety of breastfeeding,gradual adaption of breastfeeding, and coexistence of puzzles and insistence. The first stage was anxiety of breastfeeding including three themes: lack of experience in breastfeeding, conflict of breastfeeding, and noticeable fatigue during feeding.The second stage was gradual adaption of breastfeeding including four themes:family and social support, presenting regular feeding schedules, identification of mother role, and establishing a good mother-child relationship.The last stage was coexistence of puzzles and insistence which containing three themes: coexistence of confusion and perseverance, fear of returning back to work, suffering of maternal separation,and commitment of breastfeed. Conclusions In order to release the anxiety and improve the confidence of breastfeeding of primiparous women, it is vital to rely on the conjoint efforts of the family members,healthcare institutions,communities,enterprises,society and other aspects to improve the rate and duration of exclusive breastfeeding.