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a.聖路加看護学会誌 >
03巻1号 >
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| 19990827111718000308001.pdf | | 1006Kb | Adobe PDF | 見る/開く |
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| 種類: | Journal Article |
| タイトル: | 気管内吸引後のなだめる看護ケアに対する早産児の反応：事例分析 |
| タイトル別表記: | Reaction of preterm infants to soothing nursing care after endotracheal suction
case study |
| 著者: | 堀内 成子
近藤 好枝 |
| キーワード: | ストレスサイン
気管内吸引
屈曲姿勢
行動状態
早産児 |
| 掲載誌: | 聖路加看護学会誌 |
| 巻: | 3 |
| 号: | 1 |
| 開始ページ: | 1 |
| 終了ページ: | 10 |
| 発行年月日: | 30-Jun-1999 |
| ISSN: | 13441922 |
| 抄録: | 本研究の目的は、気管内吸引に伴って次々に実施される処置やケアが、早産児の生理学的および行動状態にどのような変化を生じさせているか、それがなだめる看護ケアによってどのように調整されていくか、を明らかにすることである。 対象は、呼吸管理を受けている受胎後週齢28週と29週の早産児である。生理学的及び行動状態の観察記録から、受胎後週齢、気管内吸引の構成要素および刺激様式、ケア提供者がほぼ同一の2事例4場面を選び、事例分析を行なった。 なだめる看護ケアとは、四肢の屈曲と動きの抑制および四肢躯幹への触覚刺激の提供であり、単一ケアとは、腹臥位のみの介入である。 気管内吸引およびそれに続いて行なわれた手順にはさまざまな様式と強さの刺激が含まれていた。早産児は、吸引がなされるとすぐに複数のストレス反応を示した。しかし、なだめる看護ケアが実施されると、ストレスサインは抑制され、速やかにQuiet Sleepに入り睡眠が持続した。これに対して、単一ケアでは、ストレスサインが抑制されず、心拍数とSPO2には変動が認められた。また、状態が短時間で変化し、睡眠は中断された。 分析結果から、なだめる看護ケアにおいては、吸引刺激によってストレスサインが現れたが、次第に落ち着きを取り戻していくことが認められた。 |
| 抄録別表記: | The purpose of this study was to clarify how physiological and behavioral changes occur in preterm infants in response to various procedures and care for them when endotracheal suction is performed, and how these changes are modified by soothing nursing care. Based on the records of observations of the behavior of 4 preterm infants receiving respiration management, we prepared schematic diagrems of the course of 115 sessions, including both soothing nursing care and unimodal care, as reported in our previous paper. In this study, case study was conducted by selecting 4sessions in 2 subjects in whom postconceptional age, peocedures associated with ecdotracheal suction, manner of stimulation, and care providers were matched. "Soothing nursing care" is defined as inhibition of flexion and movements of the extermities and peovision of tactile stimulation to the trunk and extremities. Unimodal care means involvement of the prone position alone in caring for preterm infants. The subjects were two preterm infants study at postconceptional age 28 and 29, respectively. Various procedures with different types of simulation were performed in association with endotracheal suction. The preterm infants showed several types of stress reaction to endotracheal suction. When the infants were cared for by sooting nursing, however, their stress was inhibited, and they rapidly fell into a quiet sleep. By contrast, unimodal care did not inhibit stress signs. It produced changes in heart rate and SpO2, altered the infants' condition, and interrupted their sleep. In conclusion, although the preterm infants showed signs of stress after suction stimulation, they gradualy stabilized when given soothing nursing care. |
| 参考文献: | 1) Als, Heidelise:Infant individuality:Assessing patterns (Eds),363-377,Frontiers in Infant Psychiatry.New York: Basic Books in press.
2) B.D.Speidel:Adverse effects of routine procedures on preterm infants, Lancet, 22, 8069, 864-866, 1978.
3) David R. Shorten: Effects of tracheal suctioning on neonates: a review and Critical Care Nursing,9,48-54,1993.
4) Anthony M.Knox:Performing endotracheal suction on Children:A literature review and implications for nursing practice, Intensive and Critical Care Nursing,9,48-54,1993.
5) Hodge, Derenda: Endotracheal suctioning and the infant: A nursing care protocol to decrease complications, Neonatal Network, 9(5), 7-15, 1991.
6) Cynthia L. Tolles, Kathleen S. Stone:National survey of neonatal network,9(5),7-15,1991.
7) Kathy Swartz, Donna M. Noonann Joy EdwardsBeckett: A national survey of endotracheal Heart and Lung,25(1),52-60,1996.
8) 近藤好枝：早産児の気管内吸引に伴う看護に関する研究, 日本看護科学会誌, 18(2), 29-39,1998.
9) Yoshie Kondo:Effect of soothing nursing care on the behavioral state of preterm infants following endotracheal suction, Japan Academy of Nursing Science, Third Internatioinal Nursing Research Conference,242,1998.
10) Als, Heidelise:Towaed a synactive theory of development: Promise for the assessment and support of intfant individuality Intant Mental Health Journal,3(4),229-243,1982.
11) Als, Heidelise, Lawhon Gretchen, Brown, Elizabeth, et al.:Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: Neonatal intendive care unit and developmental outcome, Pediatrics,78(6),1123-1132,1986.
12) Als, Heidelise, Barry M. Lester, Edward Z. Tronick,
and T. Berry Brazelton: Toward a research
instrument for the assessment of preterm infants'
behavior, Theory and research in behavioral,
Pediatrics, 1, 35-63, 1982.
13) Thoman, Evelyn B.:Sleeping and waking states in infants, A functional perspective, Neuroscience and
Biobehavioral Reviews, 14, 93-107, 1990.
14) 前掲論文, 13)
15) R. H. Woodson, C. Hamilton: Heart rate estimates
of motor activity in preterm infants, Infant Behavior
and Development, 9,283-290,1986.
16) Chessex, Philippe, Brian L. Reichman, Gaston J. E.Verellen, et al.: Relation between heart rate and
energy expenditure in the newborn, Pediatric
Research, 15, 1077-1082, 1981.
17) Edward Z. Tronick, Kathleen B. Scanlon, John W.
Scanlon: Protective apathy, a hypothesis about the
behavioral organization and its relation to clinical
and physiologic status of the preterm infant during
the newborn period, Clinics in Perinatology, 17 (1),
125-154,1990.
18) Diane Holditch-Davis: The development of sleeping
and waking states in high-risk preterm infants,
Infant Behavior and Development, 13,513-531, 1990. |
| リンクURL: | http://hdl.handle.net/10285/613 |
| 出現コレクション: | 03巻1号
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この研究成果の引用には次のURIを利用してください。:
http://hdl.handle.net/10285/613
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