مقايسه مراقبت خوشه‌اي سه و چهار پروسيجره ازنظر پاسخ‌هاي رفتاري نوزادان نارس: كارآزمايي باليني متقاطع تصادفي

COMPARISON OF CLUSTERED CARE WITH THREE AND FOUR PROCEDURES ON BEHAVIORAL RESPONSES OF PRETERM INFANTS: RANDOMIZED CROSSOVER CLINICAL TRIAL

پيش زمينه و هدف: نوزادان نارس بستري در بخش مراقبت هاي ويژه نوزادان تحت استرس مكرر قرار گرفته و دچار محروميت از خواب مي شوند. در اين راستا يكي از استراتژي هاي توصيه شده مراقبت خوشه اي مي باشد از طرفي بر مشاهده مستقيم رفتار نوزادان در زمان ارائه مراقبت هاي پرستاري تأكيد گرديده است. هدف از اين مطالعه مقايسه پاسخ هاي رفتاري نوزادان نارس در مراقبت خوشه اي با سه و چهار پروسيجر غيرتهاجمي مي باشد. مواد و روش ها: مطالعه حاضر يك كارآزمايي باليني متقاطع تصادفي است كه در سال 1392 در مركز آموزشي درماني الزهراي تبريز، ايران انجام گرفت. 31 نوزاد نارس بستري در بخش مراقبت هاي ويژه نوزادان در سن 32 هفتگي تحت مراقبت خوشه اي سه پروسيجره و چهار پروسيجره موردمطالعه قرار گرفته و ازنظر علائم رفتاري قابل مشاهده بررسي شدند. تجزيه وتحليل داده ها با استفاده از نرم افزار STATA-10 در سطح معني داري 0/05 انجام شد. يافته ها: نتايج نشان داد ميانگين مجموع علائم رفتاري بيانگر تثبيت در قبل، حين و بعد از مراقبت خوشه اي در مراقبت خوشه اي سه پروسيجره به ترتيب 1/48، 2/03، 2/45 و چهار پروسيجره 2/68، 4/23،2/87 و علائم رفتاري بيانگر استرس در مراقبت خوشه اي سه پروسيجره 2/06، 2/52، 1/97 و چهار پروسيجره 2/97، 4/03 و 3/03 بود. تفاوت آماري معني داري در قبل و بعد از مراقبت خوشه اي بين دو مداخله يافت نشد اما در حين مراقبت خوشه اي اين تفاوت معني دار بود (0/035=P). بحث و نتيجه گيري: اگرچه مراقبت خوشه اي سه پروسيجره قابل قبول تر فرض گرديد، مراقبت خوشه اي چهار پروسيجره نيز قابل قبول نشان داده شده و هر دو براي نوزادان نارس پيشنهاد مي گردد.

Comparison of clustered care with three and four procedures on behavioral responses of preterm infants: Randomized crossover clinical trial Valizadeh L[1], Avazeh M [2]*, Hosseini MB[3], Asghari Jafarabadi M[4], Conneman N[5], Babaei N[6] Received: 13 Jul , 2014 Accepted: 15 Sep , 2014 Abstract Background Aims: Preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) are under repeated stress, and they are suffering from sleep deprivation. In this respect, one of recommended strategies is clustered care. On the other hand, direct observation of infant behaviors has been emphasized at time of nursing care. The aim of this study was to compare the behavioral responses in preterm infants in clustered care with three and four noninvasive procedures. Materials Methods: This study was a randomized crossover clinical trial performed in NICU of AlZahra teaching hospital, Tabriz, Iran in 2013. Thirty one preterm infants were studied at 32 weeks age by clustered care with three and four procedures, and observable behavioral symptoms were assessed. The analysis of data was done with the use of STATA 10 software at 0.05 significant level. Results: The findings showed that mean of behavioral symptoms indicated stability in before, during and after of clustered care with three procedures, and it was 1.48, 2.03, 2.45 respectively, and four procedures 2.68, 4.23, 2.87 and behavioral symptoms indicative stress of three procedures were 2.06, 2.52, 1.97 and four procedures 2.97, 4.03, 3.03. Significant differences were not found in before and after phases between two interventions but it was significant during phase (P=0.035). Conclusion: Although clustered care with three procedures can be assumed more acceptable, clustered care with four procedures is shown acceptable too, both of them could be recommended for preterm infants. Key words: Preterm infants, clustering, caring, behavioral symptoms Address: Nursing Midwifery faculty of Tabriz University of Medical Sciences, Tabriz, Iran. Tel: (+98)4114796770,Fax:(+98)4114796969 Email: M.avazeh@yahoo.com [1]Associate professor, academic member, Nursing Midwifery faculty of Tabriz University of Medical Sciences, Tabriz, Iran. [2] MS students, Nursing Midwifery faculty of Tabriz University of Medical Sciences, Tabriz, Iran. (Corresponding Author) [3]Associate professor of Neonatology, academic member, Tabriz University of Medical Sciences, Tabriz, Iran. [4] PhD, Assistant Professor of Road Traffic Injury Prevention Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran. [5] Neonatologist and Senior NIDCAP trainer at ErasmusMC_Sophia Childrens Hospital, Rotterdam, Netherlands. [6] MS students, Nursing Midwifery faculty of Tabriz University of Medical Sciences, Tabriz, Iran.