早產兒在進食過程中的呼吸急促、發紺、疲倦等行為常令母親感到壓力，亦阻礙餵食過程中的親子互動。本研究以Barnard之親子互動模式為基礎設計餵食互動方案，以提升母親觀察早產兒進食暗示的敏感度，並使母親具備以觀察嬰兒進食暗示為基礎的餵食行為。
　　本研究目的在於瞭解餵食互動方案介入前、後，母親對早產兒進食暗示之敏感度及餵食行為的變化。研究採單組前後測準實驗研究設計，並發展觀察工具進行變項測量，資料收集以數位攝影機拍攝母親餵食早產兒過程，進而分析母親餵食行為的類別。餵食互動方案內容包括「解讀進食暗示與意義」、「餵食行為反思與調整」、「餵食練習」、「強化學習」四部份，共收案8對早產兒母子。
　　研究結果顯示：(1)母親對早產兒進食暗示的敏感度在前、後測有顯著差異，後測敏感分數明顯上升；(2)母親之低敏感、主控干擾、互惠三種餵食行為分布，在前、後測有顯著差異，且差異來自後測母親之主控干擾餵食行為減少35.4﹪，互惠餵食行為增加30.3﹪，顯示母親以暗示為基礎，支持早產兒的能力提升。
　　本研究建立了理論依據之早產兒餵食介入方案，並提醒醫護人員及早產兒父母應重視觀察能力的培養。研究中建立「早產兒餵食互動觀察系統」之信效度，可做為相關研究之工具選擇或臨床觀察應用之參考。

　　Learning how to feed a premature baby is one of the important tasks for mothers when the baby hospitalized. Mothers have to face the baby’s tachypnea, cyanosis or fatigue during feeding, which might interfere parent-infant interaction. Based on the Barnard’s parent-child interaction model, helping mother to read the feeding cues is essential for improving maternal sensitivity and contingency behavior to support baby during feeding.

　　Research purpose is to explore the change of maternal sensitivity to feeding cues and maternal feeding behavior after the intervention program. This is a quasi-experimental study with one group pretest-posttest design. The feeding interaction program composes of reading cues, reflection and modification on maternal feeding behaviors and feeding application. The Coding System of Feeding Interaction Observation was developed in this study and to measure the maternal sensitivity on feeding cues and maternal feeding behavior. A total of 8 dyads of mothers and preterm infants were recruited.

　　The results were (1) a significant improvement on maternal sensitivity of feeding cues from the score of pretest to the posttest, (2) the significant differences on maternal feeding behavior. Compare to the pretest, proportion of control-interference feeding behavior decreased 35.4% and reciprocation feeding behavior improved 30.3% on posttest.

　　This study established an evidence-base intervention program for preterm feeding and arouses the health care provider and parents should pay more attention to develop the cue-base care capability. The validity and reliability of coding system was established and to be an available instrument in research and clinical application.

一、中文部分

王保進（2002）‧視窗版SPSS與行為科學研究‧台北：心理出版社。
李明濱（1997）‧病人自主與知情同意‧醫學教育，1（4），3-13。
李芳蘭（1998）‧極低出生體重而母親之居家需求探討．未發表的碩士論文‧台北：國立
台灣大學醫學院護理學研究所碩士論文。
郭貞伶、陳雅汝（2002）‧生命的自主權‧台北：商周。
廖珍娟（2003）‧藉由教育方案增進新生兒加護中心護理人員對早產兒行為及支持性照顧
之認知‧護理研究，11(2)，82-92。

二、英文部分

1. Aita, M., & Snider, L. (2003). The art of developmental care in the NICU: A concept analysis. Journal of Advanced Nursing, 41(3), 223-224.
2. Als, H. (1986). A synactive model of neonatal behavioral organization: Framework for the assessment of neurobehavioral development in the premature infant and for support of infants and parents in the neonatal intensive care environment. In J. K. Sweeney (Ed.), High risk neonate: Developmental theory perspectives. (pp. 3-53). Binghamton, NY: Haworth Press.
3. Als, H. (1999). Reading the premature infamt. In E. Goldson (Ed.), Nurturing the premature infant: developmental interventions in the neonatal intensive care nursery (pp. 18-85). New York, NY: Oxford.
4. Als, H., Lawhon, G., Brown, E., Gibes, R., Duffy, F. H., McAnulty, G., & Blickman, J. G. (1986). Individualized behavioral and environmental care for the very low birth weight preterm infant at high risk for bronchopulmonary dysplasia: Neonatal intensive care unit and developmental outcome. Pediatrics, 78(6), 1123-1132.
5. Als, H., Lawhon, G., Duffy, F. H., McAnulty, G. B., Gibes-Grossman, R., & Blickman, J. G. (1994). Individualized developmental care for the very low-birth-weight preterm infant. Journal of the American Medical Association, 272(11), 853-858.
6. Ancona, J., Shaker, C. S., Puhek, J., & Garland, J. S. (1998). Improving outcomes through a developmental approach to nipple feeding. Journal of Nursing Care Quality, 12(5), 1-4.
7. Anderson, C. J. (1981). Enhancing reciprocity between mother and neonate. Nursing Research, 30(2), 89-93.
8. Antonakos, C. L., & Colling, K. B. (2001). Using measures of agreement to develop taxonomy of passivity in dementia. Research in Nursing & Health, 24, 336-343.
9. Baker, J. K., Borchers, D. A., Cochran, D. T., Kaltofen, K. G., Orcutt, D., & Peacock, J. A. (1994). Parent-child interaction model. In A. M. Tomey (Ed.), Nursing theorists and their work (3rd ed., pp. 246-268). St. Louis, MO: Mosby.
10. Barnard, K. E. (1990). Key to careging study guide. Seattle: NCAST Programs, University of Washington.
11. Barnard, K. E., Bee, H. L., & Hammond, M. A. (1984). Developmental changes in maternal interactions with term and preterm infants. Infant Behavior and Development, 7, 101-113.
12. Barnard, K. E., & Morisset, C. E. (1993). Preventive interventions: Enhancing parent-infant relationships. In C. H. Zeanah (Ed.), Handbook of infant mental health (pp. 386-401). New York, NY: Guilford Press.
13. Blackburn, S. (1983). Fostering behavioral development of high-risk infants. Journal of Obstetric, Gynecologic and Neonatal Nursing, 12(3 Suppl), 76s-86s.
14. Blackburn, S., & Vandenberg, K. A. (1993). Assessment and management of neonatal neurobehavioral development. In L. P. Gunderson (Ed.), Comprehensive neonatal nursing: A physiologic perspective (pp. 1108-1119). Philadelphia, PA: W. B. Saunders.
15. Bottorff, J. L. (1994). Development of an observational instrument to study nurse-patient touch. Journal of Nursing Measurement, 2(1), 7-24.
16. Brazelton, T. B. (1984). Neonatal behavioral assessment scale. (2nd ed.). Philadelphia, PA: Lippincott.
17. Brazelton, T. B. (1993). Why children and parents must play while they eat: An interview with T. Berry Brazelton, MD. Interview by Nancy I. Hahn. Journal of the American Dietetic Association, 93(12), 1385-1387.
18. Brazelton, T. B., Koslowski, B., & Main, M. (1974). The origins of reciprocity : The early mother-infant interaction. In M. Lewis & L. A. Rosenblum (Eds.), The effect of the infant on its caregiver. (pp. 49-76). New York, NY: Wiley.
19. Brookfield, S. (1987). Developing critical thinkers: Challenging adults to explore alternate ways of thinking and acting. San Francisco, CA: Jossey-Bass.
20. Bu'Lock, F., Woolridge, M. W., & Baum, J. D. (1990). Development of co-ordination of sucking, swallowing and breathing: Ultrasound study of term and preterm infants. Development Medicine and Child Neurology, 32, 699-678.
21. Burns, N., & Grove, S. K. (2001). The practice of nursing research: Conduct, critique and utilization. Philadelphia, PA: Saunders.
22. Cagan, J. (1995). Feeding readiness behavior in preterm infants. Neonatal Network, 14(2), 82.
23. Carmines, E. G., & Zeller, R. A. (1979). Reliability and validity assessment. Thousand Oaks, CA: Sage.
24. Case-Smith, J., Allen, A. S., & Pratt, P. N. (1996). Feeding and oral motor skills. In J. Case-Smith, A. S. Allen, & P. N. Pratt (Eds.), Occupational therapy for children (3rd ed., pp. 430-449). St. Louis, MO: Mosby.
25. Censullo, M. (1994). Strategy for promoting greater responsiveness in adolescent parent-infant relationships: Report of a pilot study. Journal of Pediatric Nursing, 9(5), 326-332.
26. Cohen, J. (1960). A coefficient of agreement for nominal scale. Educational and Psychological Measurement, 20, 37-46.
27. Comrie, J. D., & Helm, J. M. (1997). Common feeding problems in the intensive care nursery: Maturation, organization, evaluation, and management strategies. Seminars in Speech and Language, 18(3), 239-261.
28. Cranton, P. (1994). Understanding and promoting transformative learning: A guide for educators of adults. San Francisco, CA: The Jossey-Bass.
29. Crow, R. A., Fawcett, J. N., & Wright, P. (1980). Maternal behavior during breast-and bottle-feeding. Journal of Behavioral Medicine, 3(3), 259-277.
30. Divitto, B., & Glodberg, S. (1983). Talking and sucking: Infant feeding behavior and parent stimulation in dyads with different medical histories. Infant Behavior and Development, 6, 157-165.
31. Einarsson-Backes, L. M., Deitz, J., Price, R., Glass, R., & Hays, R. (1994). The effect of oral support on sucking efficiency in preterm infants. The American Journal of Occupational Therapy, 48(6), 490-498.
32. Flagler, S. (1988). Maternal role competence. Western Journal of Nursing Research, 10(3), 274-290.
33. Garvin, B. J., Kennedy, C. R., & Cissna, K. N. (1988). Reliability in category coding systems. Nursing Research, 37(1), 52-55.
34. Goldberg, S. (1979). Premature birth: Consequences for the parent-infant relationship. American Scientist, 67, 214-220.
35. Goldsmith, J. W. (1981). Methodological consideration in using videotape to establish rater reliability. Nursing Research, 30(2), 124-127.
36. Harrison, L., Sherrod, R. A., Dunn, L., & Olivet, L. (1991). Effects of hospital-based instruction on interactions between parents and preterm infants. Neonatal Network, 9(7), 27-33.
37. Humphry, R., & Thigpen-Beck, B. (1997). Caregiver role: Ideas about feeding infants and toddlers. Occupational Therapy Journal of Research, 17(4), 237-263.
38. Humphry, R. (1991). Impact of feeding problems on the parent-infant relationship. Infant Young Children, 3(3), 30-38.
39. Humphry, R. (1995). The nature and diversity of problems leading to failure to thrive. Occupational Therapy in Health Care, 9(2/3), 73-89.
40. Jones, R. A. (1996). Using observation to test idea. In R. A. Jones (Ed.), Research methods in the social and behavioral sciences (2nd ed., pp. 73-101). Sunderland, MA: Sinauer Associate.
41. LaGasse, L. L., Messinger, D., Lester, B. M., Seifer, R., Tronick, E. Z., Bauer, C. R., Shankaran, S., Bada, H. S., Wright, L. L., Smeriglio, V. L., Finnegan, L. P., Maza, P. L., & Liu, J. (2003). Prenatal drug exposure and maternal and infant feeding behaviour. Archives of Disease in Childhood: Fetal and Neonatal Edition, 88(5), F391-F399.
42. Lauer, R. H., & Handel, W. H. (1983). Social psychology: The theory and application of symbolic interactionism. Englewood Cliffs, NJ: Prentice-Hall.
43. Lawhon, G. (2002). Facilitation of parenting the premature infant within the newborn intensive care unit. Journal of Perinatal & Neonatal Nursing, 16(1), 71-81.
44. Letourneau, N. (2001). Improving adolescent parent-infant interactions: A pilot study. Journal of Pediatric Nursing, 16(1), 53-62.
45. Lieb, S. (1991, Fall). How people learn: Principle of adult learning. In Faculity guide book-teaching tips. Retrieved January 12, 2005, from http://www.hcc.hawaii.edu/ intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm
46. Lobo, M. L., Barnard, K. E., & Coombs, J. B. (1992). Failure to thrive: A parent-infant interaction perspective. Journal of Pediatric Nursing, 7(4), 251-261.
47. Loo, K. K., Espinosa, M., Tyler, R., & Howard, J. (2003). Using knowledge to cope with stress in the NICU: How parents integrate learning to read the physiologic and behavioral cues of the infant. Neonatal Network, 22(1), 31-37.
48. Martin, J. A., Hamilton, B. E., Ventura, S. J., Menacker, F., & Park, M. M. (2002). Birth: Final data for 2000. National Vital Statistics Reports, 50(2), 79.
49. Mathew, O. P. (1991). Science of bottle-feeding. The Journal of Pediatrics, 119(4), 511-519.
50. Matthews, C. L. (1994). Supporting suck-swallow-breath coordination during nipple feeding. The American Journal of Occupational Therapy, 48(6), 561-562.
51. McCain, G. C. (1992). Facilitating inactive awake states in preterm infants: A study of three interventions. Nursing Research, 41(3), 157-160.
52. McCain, G. C. (1997). Behavioral state activity during nipple feedings for preterm infants. Neonatal Network, 16(5), 43-47.
53. McCain, G. C. (2003). An evidence-based guideline for introducing oral feeding to healthy preterm infants. Neonatal Network, 22(5), 45-50.
54. McCain, G. C., Gartside, P. S., Greenberg, J. M., & Lott, J. W. (2001). A feeding protocol for healthy preterm infants that shortens time to oral feeding. Journal of Pediatrics, 139(3), 374-379.
55. Meins, E., Fernyhough, C., Fradley, E., & Tuckey, M. (2001). Rethinking maternal sensitivity: Mothers' comments on infants' mental predict security of attachment at 12 months. Journal of Child Psychology and Psychiatry, 42(5), 637-648.
56. Mello, D. F., Rocha, S. M. M., Scochi, C. G. S., & Lima, R. A. G. (2002). Brazilian mothers' experiences of home care for their low birth weight infants. Neonatal Network, 21(1), 30-34.
57. Mentro, A. M., Steward, D. K., & Garvin, B. J. (2002). Infant feeding responsiveness: A conceptual analysis. Journal of Advanced Nursing, 37(2), 208-216.
58. Meyer, R. M. (2000). Using adult learning concepts to assist patients in completing advance directices. The Journal of Continuing Education in Nursing, 31(4), 174-179.
59. Mezirow, J. (1997). Transformative learning: theory to practice. New Directions for Adult and Continuing Education, 74, 5-12.
60. Mezirow, J. (1998). On critical reflection. Adult Education Quarterly, 48(3), 185-198.
61. MMWR. (2002). Infant mortality and low birth weight among black and white infants－United States, 1980-2000. Morbidity and Mortality Weekly Report, 51(27), 589-592.
62. NCAST-AVENUW (2004). Parent Child Interaction Program. In NCAST program, University of Washington. Retrieved Decemnber 10, 2004, from http://www. ncast.org/p-pci.asp.
63. Palmer, M. M. (1993). Identification and management of the transitional suck pattern in premature infants. Journal of Perinatal and Neonatal Nursing, 7(1), 66-75.
64. Palmer, M. M., Crawley, K., & Blanco, I. A. (1993). Neonatal oral-motor assessment scale: A reliability study. Journal of Perinatology, 8(1), 28-35.
65. Palmer, M. M., & Heyman, M. B. (1999). Developmental outcome for neonate with dysfunctional and disorganized sucking patterns: preliminary findings. The Transdisciplinary Journal, 9(3), 299-308.
66. Perry, S. E. (1982). Parents' perceptions of their newborn following structured interactions. Nursing Research, 32(4), 208-212.
67. Pickler, R. H., Mauck, A. G., & Geldmaker, B. (1997). Bottle-feeding histories of preterm infants. Journal of Obstetric, Gynecologic and Neonatal Nursing, 26(4), 415-419.
68. Polit, D. F., & Hungler, B. P. (1999). Nursing research principles and methods (5th ed.). Philadelphia, PA: Lippincott
69. Pollitt, E., & Wirtz, S. (1981). Mother-infant feeding interaction and weight gain in the first month of life. Journal of the American Dietetic Association, 78(6), 596-601.
70. Pridham, K., Kosorok, M. R., Greer, F., Carey, P., Kayata, S., & Sondel, S. (1999). The effects of prescribed versus ad libitum feedings and formula caloric density on premature infant dietary intake and weight gain. Nursing Research, 48(2), 86-93.
71. Pridham, K. F., Knight, C. B., & Stephenson, G. R. (1989). Mothers' working models of infant feeding: description and influencing factors. Journal of Advanced Nursing, 14, 1051-1061.
72. Pridham, K. F., Lin, C. Y., & Brown, R. (2001). Mothers' evaluation of their caregiving for premature and full-term infants through the first year: Contributing factors. Reaserch in Nursing & Health, 24, 157-169.
73. Pridham, K. F., Schroeder, M., Brown, R., & Clark, R. (2001). The relationship of a mother's working model of feeding to her feeding behavior. Journal of Advanced Nursing, 35(5), 741-750.
74. Resnick, M. B., Eyler, F. D., Nelson, R. M., Eitzman, D. V., & Bucciarelli, R. L. (1987). Developmental intervention for low birth weight infants: improved early development outcome. Pediatrics, 80(1), 68-74.
75. Roberts, F. (1983). Infant behavior and the transition to parenthood. Nursing Research, 32(4), 213-217.
76. Rosner, B. (2000). Hypothesis testing: Categorical data. In B. Rosner (Ed.), Fundamentals of biostatistics (5th ed., pp. 410). Pacific Grove, CA: Duxbury.
77. Safra, J. E., Yannias, C. S. & Goulka, J. E. (Eds.). (1998). The new encyclopadia britannica: Ready reference (15th ed. Vol. 4). Chicago, IL: Encyclopadia Britannica Inc.
78. Salokorpi, T., Rautio, T., Sajaniemi, N., Serenius-Sirve, S., Tuomi, H., & Wendt, L. (2001). Neurological development up to the age of four years of extremely low birthweight infants born in southern Finland in 1991-94. Acta Paediatrica, 90, 218-221.
79. Satter, E. (1990). The feeding relationship: problems and interventions. The Journal of Pediatrics, 117, s181-s189.
80. Satter, E. M. (1986). The feeding relationship. Journal of the American Dietetic Association, 86(3), 352-356.
81. Saunders, R. B., Friedman, C. B., & Stramoski, P. R. (1991). Feeding preterm infant schedule or demand? Journal of Obstetric, Gynecologic and Neonatal Nursing, 20(3), 212-218.
82. Shaker, C. S. (1999). Nipple feeding preterm infants: An individualized, developmentally supportive approach. Neonatal Network, 18(3), 15-22.
83. Sidani, S., & Braden, C. J. (1998a). Intervention variables. In C. J. Braden (Ed.), Evaluating nursing interventions: A theory-driven approach (pp. 105-116.). Thousand Oaks, CA: Sage.
84. Sidani, S., & Braden, C. J. (1998b). The theory-driven approach to effectiveness research. In C. J. Braden (Ed.), Evaluating nursing interventions: A theory-driven approach (pp. 41-62). Thousand Oaks, CA: Sage.
85. Suderman, E. M., Deatrich, J. V., Johnson, L. S., & Sawatzky-Dickson, D. M. (2000). Action research sets the stage to improve discharge preparation. Pediatric Nursing, 26(6), 571-577.
86. Suen, H. K., & Ary, D. (1989a). Reliability: Conventional methods. In D. Ary (Ed.), Analyzing quantitative behavioral observation data (pp. 99-129). Hillsdale, NJ: Lawrence Erlbaum Associate.
87. Suen, H. K., & Ary, D. (1989b). Validity. In D. Ary (Ed.), Analyzing quantitative behavioral observation data (pp. 157-192). Hillsdale, NJ: Lawrence Erlbaum Associate.
88. Sumner, G., & Spietz, A. (1994a). The Barnard model. In NCAST caregiver/ parent-child interaction feeding manual (pp. 8-11). Seattle: NCAST Publications, University of Washington.
89. Sumner, G., & Spietz, A. (1994b). Child communication cues. In NCAST caregiver/parent-child interaction feeding manual (pp. 29-40). Seattle: NCAST Publications, University of Washington.
90. Sumner, G., & Spietz, A. (1994c). Concepts used in the feeding and teaching scale. In NCAST caregiver/parent-child interaction feeding manual (pp. 12-14). Seattle: NCAST Publications, University of Washington.
91. Sumner, G., & Spietz, A. (1994d). A quick summary of what the feeding scale measures. In NCAST caregiver/parent-child interaction feeding manual (pp. 103-116). Seattle: NCAST Publications, University of Washington.
92. Thoman, E. B., Turner, A. M., Leiderman, P. H., & Barnett, C. R. (1970). Neonate-mother interaction: Effects of parity on feeding behavior. Child Development, 41(4), 1103-1111.
93. Thoyre, S. M. (2000). Mothers' ideas about their role in feeding their high-risk infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 29(6), 613-624.
94. Thoyre, S. M. (2001). Challenges mothers identify in bottle feeding their preterm infants. Neonatal Network, 20(1), 41-50.
95. Vandenberg, K. A. (1990). Nippling management of the sick neonate in the NICU: The disorganized feeder. Neonatal Network, 9(1), 9-16.
96. Waber, B., Hubler, E. G., & Padden, M. L. (1998). A comparison of outcomes in demand versus schedule formula-fed premature infants. Nutrition in Clinical Practice, 13, 132-135.
97. Widmayer, S. M., & Field, T. M. (1981). Effects of Brazelton demonstrations for mothers on the development of preterm infants. Pediatrics, 67(5), 711-714.
98. Wilcox, A. J. (2001). On the importance and the unimportance of birthweight. International Journal of Epidemiology, 30(6), 1233-1241.
99. Wolf, L. S., & Glass, R. (1992). Feeding and swallowing disorders in infancy: Assessment and management. Tucson, AZ: Therapy Skill Builders.
100. Zahr, L., & Cole, J. (1991). Assessing maternal competence and sensitivity to premature infants' cues. Issues in Comprehensive Pediatric Nursing, 14(4), 231-240.
101. Zahr, L., & Balian, S. (1995). Responses of premature infants to routine nursing interventions and noise in the NICU. Nursing Research, 44(3).