Construction And Application On Closed-Loop Mode Of Three Factors Based On Solution-Focused Approach In Premature Infants

Objective 1.To establish the closed-loop management mode of three factors based on Solution-Focused Approach,and to verify application effectin in Home Care of Premature Infants.2.To introduce Special Needs Kids Questionnaire,and provide assessment tools for continuous nursing service.3.To evaluate the effectiveness of the closed-loop management mode of three factors based on Solution-Focused Approach in Home Care of Premature Infants,such as physical development,infants’ intellectual development,sleep efficiency,readmission rate,as well as mothers’ self-efficacy,coping style,family hardiness,maternal and child interaction,status of continuing care service.Methods 1.First,we had the interview with parents of premature infants and staff.We used Home Care of Premature Infants compiled by the research team as a guide to intervene and query a large number of literature,to formulate intervention pattern draft,then we establishde the closed-loop management mode of three factors based on Solution-Focused Approach by Delphi expert enquiry.2.Our research team translated the scale after the original author,s authorization,then we had the item analysis,exploratory factor analysis and confirmatory factor analysis,content validity,retest reliability test.3.We selected 82 cases of premature infants ande their parents with convenience sampling method who went to the hospital physical examination between August 2016 and December 2016 and belonged to 10 community for research.The premature infants were randomly divided into experimental group and the control group(n = 41),finally 74 cases completed the follow-up.The experimental group received the traditional hospital care and the closed-loop management mode of three factors based on Solution-Focused Approach,and the control group received only the traditional hospital care.Infants’ physical development,sleep efficiency,were collected at the correction 4th、6th、12 th-month.Mothers’ self-efficacy,coping style,family hardiness were collected at the first entry、 the correction 4th、6th、12 th-month.Maternal and child interaction were collected at the first entry、the correction 4th、6th.Readmission rate,as well as status of continuing care service were collected at the correction 12 th.Shapiro-Wilk was used for Normal Test,independent sample t(t’)test was used for measurement data,and Mann-Whitney U was usded for non normal date;The counting data were measured by Chi-square analysis and Fisher probability method.Results 1.Hospital-commumity-family collaboration for premature infants was establishde based on Solution-focused Approach,Closed-loop Management Mode,Home Care on Focus Solution Theory.The expert consultation concluded that the average value of all items was 4.97 and the Coefficient of Variation(CV)was 0 ~ 0.041,which were less than 0.20,which reached the expected target.Kendeer coefficients was 0.317 and 0.426(P < 0.001).After two rounds of expert inquiry,closed-loop management mode of three factors based on Solution-Focused Approach with 5 sections,and 35 entries was formed,including the purpose of the model,the place of implementation of the model,the organization of the model,the accusation of nurses in the model,and the working content of the model to provide a comprehensive and scientific basis for intervention research.2.Introduction and translation of assessment tools: With the authorization of the original authors,the study team conducted translation and reliability test of the original Spe NK-Q.Five common factors were extracted from exploratory factor analysis that interpreted the cumulative variation of 73.704%.The results of confirmatory factor analysis indicated that the model had a satisfactory goodness-of-fit:χ2/df=1.492,Root Mean Square Error of Approximation(RMSEA)=0.047,composite reliability were ranged from0.6904~0.8990;Reliability analysis showed that Cronbach’s α were ranged from 0.797 to 0.916;Split-half were ranged from 0.612 to 0.833。Retest correlation coefficients ranged from 0.769 to 0.962(P<0.01).The scale includes 20 iterms and 5 dimensions,which have high reliability and validity,and meet the requirements of metrology,and can be used to measure the status of the implementation effect of the continuity of care of premature infants in China.3.Empirical Research Analysis:(1)Each area DQ of infants in the experimental group were higher than the control group(P<0.05)at 12th;Repetitive measure analysis of variance:Three times points(4th,6th and 12th),discarding of time factor,preterm intants’ DQ scores of each area were significantly different in two groups(p<0.05).Discarding of intervention factor,different points in time,preterm intants ’ DQ scores of gross motor movement,fine movement,adaptability,language were improved significantly(P<0.05).Interventional effect and time effect have no interaction(P>0.05).(2)The height,weight,head circumference and sleep efficiency of infants in the experimental group were higher than the control group(P<0.05)at 12th;Repetitive measure analysis of variance:Three times points(4th,6th and 12th),discarding of time factor,preterm intants’ height,weight and sleep efficiency were significantly different in two groups(P<0.05).Discarding of intervention factor,different points in time,preterm intants’ height,weight,head circumference and sleep efficiency were improved significantly(P<0.05).Interventional effect and time effect have interaction in height,weight and head circumference(P<0.05).The readmission rate in the experimental group was significantly lower than control group(χ2=4.413,P<0.05)(3)The scores of SICS and four dimensions of infants,mothers in the experimental group were higher than the control group(P<0.05)at 12th;Repetitive measure analysis of variance:four times points(before intervention,4th,6th and 12th),discarding of time factor,scores of SICS and four dimensions of infants,mothers were significantly different in two groups(P<0.05).Discarding of intervention factor,different points in time,scores of SICS,Promotion of Development,health care and feeding dimensions of infants,mothers were improved significantly in both groups(P<0.05);Interventional effect and time effect have interaction in Promotion of Development,safety,feeding dimensions and SICS.(4)The scores of Positive Coping of infants,mothers in the experimental group were higher than the control group(P<0.05),scores of Negative Coping of infants,mothers in the experimental group were lower than the control group(P<0.05)at 12th;Repetitive measure analysis of variance:our times points(before intervention,4th,6th and 12th),discarding of time factor,scores of Positive Coping and Negative Coping of infants,mothers were significantly different in two groups(P<0.05).Discarding of intervention factor,different points in time,scores of Negative Coping of infants,mothers were significantly different in two groups(P<0.05);Interventional effect and time effect have interaction in scores of Positive Coping and Negative Coping.(5)The scores of FHI and three dimensions of infants,mothers in the experimental group were higher than the control group(P<0.05)at 12th;Repetitive measure analysis of variance : four times points(before intervention,4th,6th and 12th),discarding of time factor,scores of FHI and three dimensions of infants,mothers were significantly different in two groups(P<0.05).Discarding of intervention factor,different points in time,scores of FHI,Commitment and Challenge of infants,mothers were significantly different in two groups(P<0.05);Interventional effect and time effect have interaction in scores of Commitment,Control and FHI(P<0.05).(6)The scores of NCAFS in the experimental group were higher than in the control group(P<0.05)at 6th;Repetitive measure analysis of variance:three times points(before intervention,4th and 6th),discarding of time factor,scores of NCAFS were significantly different in two groups(P<0.05).Discarding of intervention factor,different points in time,scores of NCAFS were significantly different in two groups(P<0.05);Interventional effect and time effect have interaction in scores of NCAFS(P<0.05).(7)The scores of Spe NK-Q and four dimensions in the experimental group were higher than the control group(P<0.05)at 12 th,indicting that parents of preterm infants were more Satisfactory in the experimental group thano in the control group.Conclusion 1.Spe NK-Q has good reliability and validity,which can be used to measure the status of the implementation effect of the continuity of care of premature infants in China.2.The closed-loop management mode of three factors based on Solution-Focused Approach in Home Care of Premature Infants can promote the neuropsychological development,physical development and sleep efficiency of premature infants and reduce the rate of readmission.It has improved the self-efficacy of the mother and the resilience of the family,improved the coping style of the mother and the interaction between mothers and children,and raised the satisfaction of the parents of premature infants with the continuing care service.