کاربرد تئوری اورم در ارتقای رفتارهای خودمراقبتی زنان باردار در معرض خطر زایمان زودرس: یک کارآزمایی بالینی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناس ارشد مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 مربی گروه مامایی، مرکز تحقیقات مراقبت مبتنی بر شواهد، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 دانشیار گروه مامایی، مرکز تحقیقات ایمنی بیمار، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

4 مربی گروه پرستاری، مرکز تحقیقات مراقبت مبتنی بر شواهد، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

5 استادیار گروه زنان و مامایی، مرکز تحقیقات سلامت زنان، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

چکیده

مقدمه: یکی از پرکاربردترین تئوری‌ها در زمینه خودمراقبتی، تئوری اورم است. بر اساس این تئوری، چنانچه بیماران با استفاده از حداکثر توانمندی خود به انجام اقدامات خودمراقبتی بپردازند، به صورت سریع‌تر و جامع‌تر سلامتی خود را باز می­یابند. مطالعه حاضر با هدف تعیین کاربرد تئوری اورم در ارتقای رفتارهای خودمراقبتی زنان باردار در معرض خطر زایمان زودرس انجام شد.
روش‌کار: این مطالعهکارآزمایی بالینی در سال 95-1394 بر روی 176 زن باردار 26-24 هفته در معرض خطر زایمان زودرس مراجعه کننده به مراکز بهداشتی- درمانی وابسته به دانشگاه علوم پزشکی شهر مشهد انجام شد. ابزارهای مورد استفاده شامل پرسشنامه غربالگری زایمان زودرس هولبروک، فرم مشخصات فردی و مامایی و پرسشنامه اقدامات مراقبت‌های دوران بارداری هارت بود. بر اساس پرسشنامه غربالگری زایمان زودرس هولبروک، افراد واجد شرایط ورود به مطالعه انتخاب شدند. بر اساس پرسشنامه اقدامات مراقبت­های دوران بارداری هارت، نیازهای آموزشی گروه مداخله و رفتار­های خودمراقبتی ارزیابی شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 16) و آزمون‌های آنالیز واریانس اندازه‌های تکراری، کای دو، تست دقیق فیشر و من ویتنی یو انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: قبل از مداخله آموزشی، میانگین نمره خودمراقبتی دوران بارداری در دو گروه مداخله و کنترل تفاوت آماری معناداری نداشت (899/0=p). اما در هفته اول (0001/0p<) و دوم بعد از مداخله (0001/0p<) و همچنین پس از زایمان (0001/0p<)، میانگین نمره خودمراقبتی دوران بارداری در گروه مداخله بالاتر از گروه کنترل بود.
نتیجه‌گیری: با توجه به نتایج مداخلات آموزشی مبتنی بر تئوری اورم در ارتقاء رفتارهای خودمراقبتی زنان باردار در معرض خطر زایمان زودرس، شناسایی و آموزش خودمراقبتی دوران بارداری مبتنی بر تئوری اورم به زنان در معرض خطر زایمان زودرس در مراکز بهداشتی- درمانی توصیه می‌شود.

کلیدواژه‌ها


عنوان مقاله [English]

Application of Orem's theory for promotion of self-care behaviors of pregnant women at risk for preterm delivery: A clinical trial

نویسندگان [English]

  • Seyedeh Mahboobeh Rezaeean 1
  • Zahra Abedian 2
  • Robab Latifnejad Roudsari 3
  • Seyed Reza Mazloom 4
  • Salmeh Dadgar 5
1 M.Sc. student of Midwifery, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2 Instructor, Department of Midwifery, Evidence-based Care Research Center, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
3 Associate Professor, Department of Midwifery, Patient Safety Research Center, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
4 Instructor, Department of Nursing, Evidence-based Care Research Center, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
5 Assistant Professor, Department of Obstetrics & Gynecology, Women's health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: One of the most widely used theories in the field of self-care is the Orem's theory. According to this theory, patients can recover more quickly and holistically if they carry out their own self cares to the best of their ability. This study was performed with aim to investigate the application of Orem's theory for promotion of self-care behaviors of pregnant women at risk for preterm delivery.
Methods: This clinical trial was done on 176 pregnant women at 24-26 gestational week at risk for preterm delivery who referred to health centers of Mashhad University of Medical Sciences in 2015-2016. The research tools included Holbrook risk-scoring for preterm labor questionnaire, demographic and obstetric questionnaire and Hart prenatal care actions scale. According to Holbrook risk-scoring for preterm labor questionnaire, the women who had inclusion criteria were selected. According to Hart prenatal care actions scale, the educational needs of intervention group and self-care behaviors were evaluated. Data were analyzed by SPSS software (Version16), and repeated measures ANOVA, Chi-square, Fisher exact and Mann–Whitney U tests. P<0.05 was considered significant.
Results: The mean score of prenatal self-care was not significantly different in intervention and control group before educational intervention (P=0.899). But one week (P<0.0001) and two weeks (P<0.0001) after educational intervention and also in postpartum period (P<0.0001), the mean score of prenatal self-care was higher in intervention group compared to control group.
Conclusion: The educational intervention based on Orem’s theory is recommended to increase the prenatal self-care behaviors of pregnant women at risk for preterm delivery, identifying and training the prenatal self-care based on Orem’s theory for women at risk for preterm birth in health care centers.

کلیدواژه‌ها [English]

  • Orem's theory
  • Preterm delivery
  • self-care
  1. Avelyn G. The Relationship between prenatal self-care practices during prenancy and birth out comes among young mothers aged 16 to 24 years delivering at Gweru Maternity Hospital DS. [Master Thesis]. Mt Pleasant: University of Zimbabwe; 2014.
  2. Rafieefar S, Attarzadeh M, Ahmadzadeh Asl M. Comprehensive system of empowering people to take care of their health. 1st ed. Tehran: Mehrravash; 2005. P. 30-40, 57-84.
  3. Habibzadeh H, Davarpanah M, Khalkhali HR. The survay of effect of utilization Orems care model on the level of self-efficacy of patients under hemodialysis in educated hospitals of Orumiye university of medical scinces. J Urmia Nurs Midwifery Facul 2012; 10(2):190-9.
  4. Meleis AI. Theoretical nursing: development and progress. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. P. 207-28.
  5. Fawcett J, Desanto-Madeya S. Contemporary nursing knowledge: analysis and evaluation of nursing models and theories. 2th ed. New York, USA: F.A Davis Company; 2006.
  6. Çapik A, Nazik E, Özdemir F. The effect of the care given usıng orem’s self-care model on the postpartum self-evaluation. Int J 2015; 8(2):393.
  7. Ghafourifard M, Ebrahimi H. The effect of Orem's self-care model-based training on self-care agency in diabetic patients. Sci J Hamadan Nurs Midwifery Facul 2015; 23(1):5-13.
  8. Hemati Z, Abasi S, Mosaviasl F, Shakerian B, Kiani D. Effect of orem’s self-care model on perceived stress in adolescents with asthma referring the asthma and allergy clinic, Isfahan, 2014. Int J Community Based Nurs Midwifery 2016; 4(3):247-55.
  9. Oshvandi K, Keshmiri K, Salavati M, Emkanjoo Z, Musavi S. Effectiveness of education based on Orem’s self-care model in self-care activity of patients with implantable cardioverter defibrillators. J Hayat 2013; 19(3):47-55. (Persian).
  10. Mahmoudzadeh Zarandi F, Raiesifar A, Ebadi A. The effect of Orems self-care model on quality of life in patients withmigraine:a randomized clinical trial. Acta Med Iran 2016; 54(3):159-64.
  11. Mohajer T. Patient education techniques. 1st ed. Tehran: Salemi; 2001.
  12. Aggleton P, Chalmers H. Nursing models and nursing practice. 1st ed. Canada: The PhilPapers Foundation; 2000. P. 27.
  13. Alligood MR. Nursing theory: utilization and application. 24th ed. New York: Elsevier Health Sciences; 2006.
  14. Mohebbi SZ, Sheikhzadeh S, Ezzati-Givi N, Shekarchizadeh H. Self-perceived oral health and its determinants among adult dental patients in a University Dental‎ Clinic in Tehran, Iran‎. J Oral Health Oral Epidemiol 2015; 4(1):30-7.
  15. Ghaffari F, Jahani N, Jafarnejad F, Esmaily H. The assessment of quality of preconception care provided to reprodactive ages women in health centers of Mashhad in 2012. [Master Thesis]. Mashhad, Iran: Mashhad University of Medical Science; 2013.
  16. Blencowe H, Cousens S, Chou D, Oestergaard M, Say L, Moller AB, et al. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013; 10(Suppl 1):S2.
  17. Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science 2014; 345(6198):760-5.
  18. Shah R, Mullany LC, Darmstadt GL, Mannan I, Rahman SM, Talukder RR, et al. Incidence and risk factors of preterm birth in a rural Bangladeshi cohort. BMC Pediatr 2014; 14(1):112.
  19. Mehran N, Abbaszadeh F, Bagheri A, Noroozi M. Relation between Home Work and Preterm Labor. J Hayat 2013; 18(5):46-54. (Persian).
  20. Miyvaneh F, Entezari AR, Khadem N, Shojaee T. Modeling the seasonal patterns of preterm deliveries: time series study in Mashhad. Iran J Obestet Gynecol Infertil 2016; 18(178):12-20. (Persian).
  21. Kamali Fard M, Alizadeh R, Sehati Shafaei F, Gojazadeh M. The effect of lifestyle on the rate of preterm birth. J Ardabil Univ Med Sci 2010; 10(1):55-63.
  22. Saling E, Drager M. Program for prevention of a considerable number of premature births. Donald Sch J Ultrasound Obstet Gynecol 2008; 58(2):118-26.
  23. Ceahan S. Effect of depression on learned resourcefulness and prenatal self care practices in pregnantwomen with and without HIV seropositivity in Thiland. [Master Thesis]. Frances: Bolton School of Nursing Case Western Reserve University; 2002.
  24. Sahebolzamani M, Shakuri A, Aliloo L, Rashidi A. The efficacy of self-care education on knowledge and performance of epileptic patients who referred to selected hospitals of Tehran universty of medical sciences in 2008. Urmia Med J 2010; 20(4):284-9.
  25. Mangolian SP, Shahanazari J, Mahmoodi M, Farokhzadian J. The effect of an educational self-care program on knowledge and performance in patients with heart failure. Iran J Med Educ 2012; 11(6):609-19.
  26. Passman R, Subacius H, Ruo B, Schaechter A, Howard A, Sears SF, et al. Implantable cardioverter defibrillators and quality of life: results from the defibrillators in nonischemic cardiomyopathy treatment evaluation study. Arch Intern Med 2007; 167(20):2226-32.
  27. Rahimi F, Gharib A, Beyramijam M, Naseri O. Effect of self-cere education on self efficacy in patients undergoing hemodialysis. Life Sci J 2014; 11(1):136-40.
  28. Kordi M, Banaei M, Asgharipour N, Mazloom SR, Akhlaghi F. Predicting self-care behaviors in women with gestational diabetes mellitus based on self-efficacy. Iran J Obestet Gynecol Infertil 2016; 19(13):6-17. (Persian).

Ennis M, Thain J, Boggild M, Baker GA, Young CA. A randomized controlled trial of a health promotion education programme for people with multiple sclerosis. Clin Rehabil 2006; 20(9):783-92