用統合發展理論於一位吸吮困難之早產兒之照護經驗

Applying the Synactive Theory of Development to the Care of a Premature Infant with Sucking Problems

透過系統性的行為觀察與家庭評估，在照護一位24週又5天的早產兒時，發現個案有吸吮困難的問題，其原因除了神經系統尚未成熟發展影響到吸吮、吞嚥等能力外，照護環境生態的混亂與未建立吸吮哺餵的照護行為皆是影響個案吸吮失敗的原因。目前國內早產兒口腔吸吮訓練圖檔較缺乏，因此筆者透過文獻搜尋並與本院物理治療師做跨領域合作共同釐訂早產兒發展吸吮訓練計畫，提供個案吸吮模式的建立，並透過統合發展理論及醫院哺餵生態環境的改善，降低環境中的光線、噪音影響睡眠，及哺餵的時間等影響吸吮照護的因素，尤其透過觀察到個案吸吮動作型態中的暗示動作──煩躁不安、口部抖動、躁動等行為，提供給案母適合的哺餵行為時機，讓個案與母親建立親子依附，來提昇出院後的照護信心。並於出院後透過居家訪視，觀察居家照護環境因素，提供立即諮詢服務，使得出院後，個案同樣能獲得持續性的照護品質達到全人照護。

Sucking problems in an infant born prematurely at 24 weeks and 5 days were identified through systematic behavioral observation and family assessment. Reasons underlying the infant’s sucking problems included poor sucking and swallowing skills due to an immature nervous system, a chaotic care environment and ecology, and unimplemented sucking and feeding care procedures. Due to the paucity of domestic diagrams related to oral-sucking training for premature babies, in addition to reviewing the literature and establishing a sucking training program to help the infant establish a regular sucking pattern, we also applied the synactive theory of development and improved the hospital feeding environment and ecology to reduce environmental factors that could affect sucking care such as ambient light and noise and feeding schedules. We observed implied infant sucking pattern actions such as restlessness, mouth shakes, and irritation and provided the mother with an appropriate feeding schedule. We helped foster parent-child attachment and enhanced the mother’s post-discharge caring confidence. Home visits were also conducted after discharge to assess the home care environment and give instant consultation, providing holistic health care with sustained quality of care.