助产士限制性会阴切开临床决策体验的质性研究  

A qualitative study on the experience of clinical decision-making for restrictive episiotomy in midwives

作　　者：刘华华[1] 陈志芳[2] 谷金丽 李小琴[3] 李霖[4] 吴蓉蓉 张凤 LIU Huahua;CHEN Zhifang;GU Jinli;LI Xiaoqin;LI Lin;WU Rongrong;ZHANG Feng

机构地区：[1]南通大学附属妇幼保健院产房,南通市226017 [2]南通大学附属妇幼保健院科研教育科,南通市226017 [3]南通大学附属妇幼保健院产科,南通市226017 [4]扬州大学附属医院产科 [5]南通大学医学院护理学院

出　　处：《中华护理杂志》2022年第22期2733-2737,共5页Chinese Journal of Nursing

基　　金：江苏省妇幼健康科研项目(F202047);南通大学临床医学专项项目(2019HY014)。

摘　　要：目的探讨助产士限制性会阴切开临床决策的体验及影响因素,以期为助产士临床决策提供依据,促进产妇安全分娩。方法采用现象学研究方法,以最大差异抽样策略于2021年10月—12月选取江苏省4所医院的13名助产士进行半结构式深度访谈,运用Colaizzi 7步分析法进行归纳、分析并提炼主题。结果共提炼出3个主题及所属的9个亚主题:临床决策的动机(专业知识的主导、减少分娩损伤的理念、孕产妇的需求及近远期获益、新生儿安全)、决策中的促进因素(同伴的支持与监督、产妇的配合、自我反思成长)、决策中的障碍因素(自主权的受限、创伤事件的干扰)。结论助产士对限制性会阴切开临床决策是一个复杂多样的过程。助产士在临床实践过程中,需发挥健康促进者和保护者的作用,保证助产服务的安全性和有效性。Objective To explore the experience and influencing factors of midwife’s clinical decision-making of episiotomy,in order to provide suggestions and bases for midwives’clinical decision-making and promote safe delivery.Methods Using phenomenological research method and maximum difference sampling,13 midwives were selected from 4 hospitals in Jiangsu Province to conduct semi-structured in-depth interviews from October to December 2021.Colaizzi 7-step analysis method was adopted for inductive analysis and theme extraction.Results A total of 3 themes and 9 sub-themes were extracted.Theme 1:decision-making motivation(dominance of professional knowledge,concept of reducing trauma in childbirth,maternal needs and short-term&long-term benefits,neonatal safety).Theme 2:promotion in decision-making(peers’support and supervision,puerpera’s cooperation and self-reflection).Theme 3:obstacles in decision-making(limitation of autonomy,interference from traumatic events).Conclusion Clinical decision-making on episiotomy for midwives is a complex and varied process.In clinical practice,midwives need to play the role of health promoter and protector to ensure the safety and effectiveness of midwifery services.

关 键 词：限制性会阴切开 助产士 质性研究 临床决策 护理 

分 类 号：R473.71[医药卫生—护理学]