降低婦科腹腔鏡手術前病人腸道準備不適症狀之改善專案

Reducing Patient Discomfort during Bowel Preparation before Gynecological Laparoscopic Surgery

10.6142/VGHN.33.4.353

陳秀蓮(Shiu-Lien Chen)；莊秋萍(Chiu-Ping Chuang)；沈華詩(Hua-Shih Shen)；柯靜芬(Ching-Fen Ke)；陳淑芬(Shun-Fen Chen)

婦科腹腔鏡手術 ； 機械性腸道準備 ； gynecological laparoscopic surgery ； mechanical bowel preparation

榮總護理

33卷4期（2016 / 12 / 01）

353 - 363

繁體中文

手術前腸道準備方法需具安全、簡便、快速的特性，現有婦科腹腔鏡術前機械性腸道準備方式病人需承受多次的經肛門灌腸，造成病人腹脹、腹痛、肛門口疼痛等不適症狀，為減少病人術前腸道準備不適症狀及程度，調查2013 年1-5月婦科腹腔鏡手術病人在術前腸道準備不適症狀及程度，統計發現病人不適症狀平均發生率為57.1 %、不適程度為5.3 分，因此引發改善動機。本專案目的為減輕行婦科腹腔鏡手術病人術前腸道準備過程的不適症狀發生率和程度，經專案成員現況分析病人術前腸道準備不適的原因為護理人員未主動評估及介入處理病人術前腸道準備不適之症狀、未即時修正腸道準備作業規範及方式、缺乏合適的護理指導工具等。本案藉強化護理人員腸道準備相關知能、修訂腸道準備作業規範、製作術前腸道準備護理指導工具等措施介入，以降低婦科腹腔鏡手術前病人腸道準備不適症狀及程度。實施結果顯示病人術前腸道準備不適症狀發生率降至20.5%、不適症狀程度減至3.5 分，有效改善病人術前腸道準備的不適症狀及程度，提升婦科腹腔鏡手術病人照護品質。

Preoperative bowel preparation requires secure, simple, and rapid procedural techniques. Because of the complicated nature of bowel preparation for traditional gynecological laparoscopic surgery, patients are subjected to multiple anus enemas, thereby causing abdominal distension, abdominal pain, and anal pain during the operational process. Several aspects of this procedure require improvement. An average of 57.1% occurrence of uncomfortable symptoms as well as a 5.3- point degree of uncomfortable symptoms before gynecological laparoscopic surgery were recorded for the period January–May 2013. The goal of this study was to reduce the occurrence of such symptoms and the degree of bowel discomfort during preparation for gynecological laparoscopic surgery. We observed the following causes for preoperative bowel discomfort: (1) lack of active assessment and intervention performed by nurses, (2) failure to update regulations in a timely manner, and (3) lack of appropriate nursing instructions and tools. The proposed resolutions were intervention through improving nurses' related knowledge and ability to perform bowel preparation, revised job specifications for performing bowel preparation, and defining nursing instructions for bowel preparation. After implementation, the aforementioned solutions were observed to be effective both in decreasing the occurrence of symptoms during preoperative preparation to 20.5% and also in reducing the degree of discomfort to 3.5. The proposed solutions are proven to reduce the occurrence of symptoms during preoperative bowel preparation and to enhance the quality of patient care.

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