ฉันรักแปล McGrath and Phillips (200

ฉันรักแปล McGrath and Phillips (2009) conducted a qualitative phenomenological study involving 20 women who had given birth via cesarean to explore the issue of newborn feeding after a second cesarean birth. Several themes, some conflicting, emerged from the data; these included a very strong desire to breastfeed, a decision to not breastfeed, and a prompt switch to bottle-feeding when obstacles occurred and, for some, a view that bottle feeding was easier and more convenient. Obstacles associated with a cesarean birth included a postponement of newborn contact with the breast, separation from the newborn, lack of skin-to-skin contact, the troubled state of the newborn after the birth and the baby receiving a bottle in the nursery before being a presented to the mother. One mother also stated that she developed engorgement resulting from the delay in contact, which made breastfeeding more difficult.
Benefits of skin-to-Skin
Contact Skin-to-skin contact (first called “Kangaroo Care”) was first studied in the early 1980s in Bogota, Colombia (Anderson, 1999). At that time, the mortality rate among premature Colombian babies was 70 percent owing to factors such as infections, respiratory problems and a lack of bonding with a parent (Anderson, 1999). Kangaroo Care evolved in the absence of medical care; of necessity, mothers of premature infants held their babies 24 hours a day, even sleeping with infants tucked under their clothing as if in a kangaroo's pouch. Researchers investigating Kangaroo Care noticed a precipitous drop in mortality: in fact, premature babies experiencing Kangaroo Care were thriving. As a result, Ludington introduced the practice of Kangaroo Care to hospitals in the United States in the early 1990s (Anderson, 1999)
The benefits associated with Kangaroo Care, mostly studied in neonatal intensive care units (NICU), include a stable heart rate (fewer bradycardic episodes), improvement in regular breathing (75 percent decrease in apneic episodes) and improved oxygen saturation. Additional benefits that have been demonstrated include less cold stress, longer period of sleep, improved weight gain, better brain development, a reduction in “purposeless” activity, decreased crying, longer periods of alertness, enhanced breastfeeding and earlier hospital discharge(Chia, Sellick& Gan, 2006: Feldman, 2001; Feldman
Eidelman, Sirota, & Weller, 2002; Mercer, 2004). Benefits to parents include earlier bonding with their infants and improved self-confidence in newborn care(Chia et al,2006; Feld- man, 2004; Feldman et al, 2002; Hung& Berg, 2011) According to the WHO(2013), breastfeeding is one of the best ways to ensure newborn and child) health and survival. Breast milk is safe, contains antibodies that help protect infants from common childhood illnesses, and is readily avail- able and inexpensive, which can help guarantee that infants receive ample nourishment. The WHO strongly suggests exclusive breastfeeding for the first 6 months of life and advises that breastfeeding should begin within an hour of birth. This can be encouraged as a part of skin-to-skin contact with newborns.
Impetus for Quality Improvement
Despite the evidence linking skin-to-skin contact with improved outcomes, many hospitals fail to integrate this practice into daily use because of barriers in obstetric settings. These barriers are more common for new mothers undergoing cesarean birth Elliott-Carter& Harper, 2012; Ferber& Makhoul, 2004; Gouchon et al., 2010)
Spurred by the “Ten Steps to Successful Breastfeeding”. QI project jointly sponsored by the WHO and UNICEF the L&D unit at our community hospital introduced skin-to-skin con tact in April 2009 as an evidence-based nursing practice with new mothers immediately post-delivery but only for vaginal births. Feedback from patients and nurses indicated high.Satisfaction and other positive outcomes; subsequently, L&D nurses were determined to provide this experience after cesarean birth as well.
The first step was to identify barriers to skin-to-skin contact immediately following cesarean birth. A collaborative group, including obstetric nurses, obstetricians and anesthesiologists identified key barriers and proposed solutions (see Box 1). To be able to assess the effects of this QI project, investigators conducted a qualitative evaluation in which mothers were asked the following questions: (1) what are your perceptions of the benefits of performing skin-to-skin contact with your newborn infant immediately following delivery? and(2) what differences do you note between your current cesarean birth experience, where immediate skin-to-skin contact was performed, and your previous elective cesarean birth experience when per forming skin-to-skin contact was not the standard of care? Conceptual Framework The investigators selected Mercers Maternal Role Attainment Theory as the
Conceptual framework for this study: Mercer recommends replacing the term "maternal role attainment” with “becoming a mother” (Mercer, 2004). According Mercer(2004) renaming the process recognizes the larger to life-transforming experience women go through when they become mothers, and that women continue to grow as mothers throughout their children's lives. Mercer's work is an appropriate conceptual fit for this study because it describes the process by which mothers gather information and seek new expert new expert.
Barriers and Solutions to Implementing Skin to Skin Contact After Cesarean
Barriers
Major surgery with sterile draping decreases ability to provide skin-to-skin contact. Pain and sedation medications used during cesarean alter a mother’s mental status, and, therefore, the ability to safely hold her newborn.
Standard practice specified transporting babies born via cesarean immediately to the nursery for admission assessment, a process that required several hours
After transport to the nursery, newborns were not returned to the L&D area. Babies born via cesarean joined their mothers for the first time in regular room on the postpartum unit, after a significant amount of time had passed.
Solutions
Skin-to-skin contact was initiated within 2 hours of birth.
Anesthesiologists were asked to not automatically sedate mother after surgery, due to the benefits of skin-to-skin and breastfeeding.
Delayed bathing the infants upon arrival from the operating room so that their temperatures would remain stable. This act would facilitate a quicker reunion in the L&D recovery room and enable skin to-skin contact and breastfeeding. Through effective communication, collaboration of all members and education allowed for positive outcomes regarding this change in practice.

ผลลัพธ์ (แอฟริกา) 1:

Ek is lief vertaling McGrath en Phillips (2009) het 'n kwalitatiewe fenomenologiese studie waarby 20 vroue wat via cesarean geboorte gegee het om die kwessie van pasgebore voeding te verken nadat 'n tweede cesarean geboorte Verskeie temas, sommige teenstrydige, blyk uit die data;. Dit sluit in '. baie sterk begeerte om te borsvoed, 'n besluit om nie te borsvoed, en 'n vinnige skakelaar te bottelvoeding wanneer struikelblokke plaasgevind en, vir sommige, 'n siening dat bottelvoeding was makliker en meer gerieflik. Struikelblokke wat verband hou met 'n cesarean geboorte ingesluit 'n uitstel van pasgebore baba. kontak met die bors, die skeiding van die pasgebore baba, 'n gebrek aan vel-tot-vel kontak, die moeilike omstandighede van die pasgebore na die geboorte en die baba wat 'n bottel in die kwekery voordat 'n aan die moeder Een ma het ook gesê dat.. SY ontwikkel stuwing gevolg van die vertraging in Kontak, wat gemaak Borsvoeding meer moeilik.
Voordele van die vel-tot-vel
kontak vel-tot-vel kontak (eers "Kangaroo Care") is vir die eerste bestudeer in die vroeë 1980's in Bogota, Colombia (. Anderson, 1999). Op daardie tyd, die sterftesyfer onder voortydige Colombiaanse babas was 70 persent weens faktore soos infeksies, respiratoriese probleme en 'n gebrek aan binding met 'n ouer (Anderson, 1999). kangaroesorg ontwikkel in die afwesigheid van mediese. sorg; noodwendig moeders van vroeggebore babas 24 uur 'n dag het hul babas, selfs slaap met babas ingesteek onder hul klere asof in 'n kangaroe se buidel Navorsers ondersoek kangaroesorg opgemerk 'n steil afname in mortaliteit: in werklikheid, premature babas ervaar Kangaroo.. Sorg is bloeiende. As gevolg hiervan, Ludington die praktyk van kangaroesorg na hospitale in die Verenigde State van Amerika in die vroeë 1990's (Anderson, 1999)
Die voordele wat verband hou met kangaroesorg, meestal bestudeer in neonatale intensiewesorgeenheid eenhede (NISE), sluit in 'n. stabiele hartklop (minder bradycardic episodes), verbetering in reëlmatige asemhaling (75 persent afname in apneic episodes) en verbeterde suurstof volop. Bykomende voordele wat gedemonstreer sluit minder koue stres, langer tydperk van slaap, verbeter gewigstoename, beter breinontwikkeling ,. 'n Vermindering in "doellose" aktiwiteit, afgeneem huil, Langer tydperke van gereedheid, Verbeterde Borsvoeding en Vroeër hospitaal ontslag (Chia, Sellick & Gan, 2006: Feldman, 2001; Feldman
Eidelman, Sirota, & Weller, die 2002; Mercer, twee duisend vier). Voordele. aan ouers insluit vroeër binding met hul babas en verbeterde selfvertroue in pasgebore sorg (Chia et al, 2006; Feld- man, 2004; Feldman et al, 2002; Hung & Berg, 2011) Volgens die WGO (2013), borsvoeding is. een van die beste maniere om pasgebore en kind) gesondheid en oorlewing. Borsmelk is veilig om te verseker, bevat teenliggaampies wat help beskerm babas van algemene kindersiektes, en is geredelik beskikbaar is ten einde en goedkoop, wat kan help waarborg dat babas ontvang genoeg voeding. Die WGO sterk dui eksklusiewe borsvoeding vir die eerste 6 maande van die lewe en beveel aan dat Borsvoeding moet begin binne 'n uur van geboorte. Dit kan aangemoedig word om as 'n deel van die vel-tot-vel kontak met pasgeborenes.
Impetus vir Gehalteverbetering
ten spyte van die bewyse wat. vel-tot-vel kontak met verbeterde uitkomste, baie hospitale versuim om hierdie praktyk in die daaglikse gebruik as gevolg van hindernisse in verloskundige instellings te integreer Hierdie hindernisse is meer algemeen vir nuwe moeders ondergaan cesarean geboorte Elliott-Carter & Harper, 2012;. Ferber & Makhoul, 2004; Gouchon et al., 2010)
aangespoor deur The "Tien stappe tot suksesvolle Borsvoeding". QI projek word gesamentlik deur die WGO en UNICEF Die L & D-eenheid by ons Gemeenskap Hospitaal geborg bekendgestel vel-tot-vel con takt in April 2009 As 'n bewys-gebaseerde. . Verpleegpraktyk met nuwe moeders onmiddellik post-aflewering, maar slegs vir vaginale Geboortes Terugvoer van pasiënte en verpleegsters aangedui High.Satisfaction en ander positiewe uitkomste;. Daarna is L & D Verpleegsters vasbeslote om die ervaring Na Cesarean geboorte sowel verskaf
die eerste stap was om te. hindernisse tot vel-tot-vel kontak onmiddellik na cesarean geboorte identifiseer. A gesamentlike groep, insluitend verloskundige verpleegsters, verloskundiges en anesthesiologists geïdentifiseer sleutel hindernisse en voorgestelde oplossings (sien Posbus 1). Om die gevolge van hierdie QI projek te evalueer, ondersoekbeamptes. het 'n kwalitatiewe evaluering in wat moeders is gevra om die volgende vrae: (1) wat is jou persepsies van die voordele van die verrigting van die vel-tot-vel kontak met jou pasgebore baba onmiddellik na aflewering en (2) wat die verskille sien jy tussen jou?. huidige cesarean geboorte-ervaring, waar onmiddellike vel-tot-vel kontak uitgevoer is, en jou vorige keuse cesarean geboorte-ervaring wanneer per vorming vel-tot-vel kontak was nie die standaard van sorg? raamwerk word die ondersoekbeamptes gekies Mercers moederlike rol Bereiking Teorie as. Die
konseptuele raamwerk vir hierdie studie: Mercer beveel die vervanging van die term "moederlike rol bereiking" met "om 'n moeder" (Mercer, 2004) Volgens Mercer (2004) hernoem Die Proses erken die groter te lewensveranderende ervaring Vroue gaan deur toe hulle.. Word Moeders, en dat vroue voortgaan om te groei soos moeders in hulle kinders se lewens. Mercer se werk is 'n toepaslike konseptuele Fit vir hierdie Studie want dit beskryf die proses waardeur Moeders inligting te versamel en soek na nuwe Expert New Expert.
Hindernisse en oplossings Implementering vel. Velkontak Na Cesarean
Hindernisse
groot operasie met steriele drapering verminder Vermoë vel-tot-vel kontak. Pyn te voorsien en sedasie medisyne wat gebruik word tydens Cesarean Alter n Moeder se geestelike status en, dus, is die vermoë om veilig hou haar pasgebore baba.
Standard praktyk wat vervoer word. Babas onmiddellik Gebore via Cesarean aan Die Kwekery vir Toelating Assessering, 'n proses wat vereis Verskeie ure
Na Vervoer Die Kwekery, pasgeborenes was nie teruggekeer na die L & D Area. Babas via Cesarean geword van hul moeders vir die eerste keer in 'n gereelde kamer op die postpartum. Eenheid, Na 'n beduidende bedrag van die tyd verby is.
Solutions
vel-tot-vel kontak is geïnisieer is binne 2 uur na geboorte.
Anesthesiologists is gevra om nie outomaties besadigde Moeder na die operasie, te danke aan die voordele van die vel-tot-vel en borsvoeding.
vertraag bad die babas by aankoms van die operasie kamer sodat hul temperature stabiele sou bly. Hierdie wet sal 'n vinniger reünie in die L & D herstel kamer te fasiliteer en in staat stel om die vel tot-vel kontak en borsvoeding. Deur effektiewe kommunikasie, samewerking van alle lede en opvoeding. toegelaat vir positiewe uitkomste ten opsigte van hierdie verandering in die praktyk.