提升腦中風病人執行吞嚥訓練自我練習完整率

Improving the Completion Rate of Swallowing Selftraining Among Stroke Patients

10.6142/VGHN.201809_35(3).0010

黃婷(Ting Huang)；張瑛瑛(Ying-Ying Chang)；廖若伶(Jo-Ling Liao)；黃春佈(Chun-Pu Huang)；廖月鳳(Yeng-Fung Liao)；施美伶(Mei-Ling Shih)

吞嚥困難 ； 吞嚥訓練 ； 腦中風 ； dysphagia ； swallowing training ； stroke

榮總護理

35卷3期（2018 / 09 / 01）

314 - 321

繁體中文

吞嚥困難為腦中風病人常見合併症，若能早期評估，確認病人吞嚥困難症狀，儘早執行吞嚥訓練，並督促病人每日自我練習，將可提升吞嚥功能，縮短鼻胃管留置時間。單位病人執行吞嚥訓練自我練習率為0%，故引發動機，專案目地旨在提升腦中風病人執行吞嚥訓練自我練習率。經現況分析確認練習率低的原因為缺乏督促病人吞嚥訓練練習機制及訓練紀錄、護理人員吞嚥評估訓練專業知能不足、缺乏吞嚥訓練衛教資料。經制定吞嚥評估訓練照護流程及吞嚥訓練自我練習評核表、安排相關在職教育與評核機制、製作吞嚥訓練衛教資料等措施，將吞嚥訓練自我練習完整率提升至94.4%，鼻胃管脫離率也由25%增加至53.8%，達專案目標。建議將督促病人吞嚥訓練自我練習機制推廣至頭頸部手術、腦創傷有吞嚥困難患者，提升病人照護及生活品質。

Dysphagia is a common complication among stroke patients. Early assessment and confirmation of dysphagia, implementing swallowing training as soon as possible, and urging patients to engage in self-training daily to improve swallowing function shorten the nasogastric tube indwelling time. Because the swallowing self-training rate of patients was 0%, we aimed to improve the rate of swallowing self-training among stroke patients. Analysis revealed that the reasons for the low practice rate were lack of a swallowing-training self-practice mechanism and record, deficiencies in the swallowing assessment and training knowledge of nursing staff, and lack of health education information for swallowing training. Swallowing assessment training and care procedures, a daily swallowing assessment training exercise schedule, related on-the-job education and assessment mechanisms, and swallowing training materials were implemented. The swallowing self-training rate increased to 94.4%, and the rate of detachment from nasogastric tube increased from 25% to 53.8%. Therefore, self-training mechanisms for supervising a patient's swallowing training should be promoted for head and neck surgery and patients with brain trauma who have dysphagia, thus improving patient care and quality of life.

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