提升護理師執行產後乳房穴位刮痧的完整率

Improving the Rate of Postpartum Breast Acupoint Scraping Performed by Nurses

10.6142/VGHN.202309_40(3).0010

洪富如(Fu-Ju Hung)；林資諺(Zi-Yan Lin)；劉雅燕(Ya Yen Liu)；翁御靜(Yu-Ching Weng)；歐湘鳳(Shiang-Ferng Ou)

產後乳房 ； 穴位刮痧 ； postpartum ； acupoint scraping

榮總護理

40卷3期（2023 / 09 / 01）

313 - 321

繁體中文;英文

政府推動母嬰親善政策鼓勵哺餵母乳至少6個月，以促進母嬰健康，然產婦常因乳汁排出不順、乳管阻塞、奶脹疼痛或乳腺炎而放棄母乳哺餵。本單位推行產後乳房穴位刮痧，運用刺激皮膚與經絡穴道，疏通經絡，順暢血液流通，促進乳汁排出，提高局部組織痛閾，減輕奶脹不適感及改善奶脹，發現護理師於臨床照護執行上有困難且完整性僅有51.43%。分析導因：沒有足夠時間、懷疑執行成效、不清楚穴位點的位置、沒有標準操作流程及工具不足。以決策矩陣分析採取六個措施：實施降低照護人數、舉辦在職教育、單位放置乳房模具回覆示教、制訂標準技術、拍攝刮痧技術影片及增購刮痧板。經對策實施後護理師執行產後乳房穴位刮痧完整率由51.43%提升至97.14%，達專案目標。希望透過專案藉由中醫護理刮痧知識技能，增加產後哺乳婦女的照護品質。

The government of Taiwan promotes mother-baby friendly policies to encourage breastfeeding for at least 6 months to promote the health of mothers and babies. However, mothers often give up breastfeeding due to poor milk discharge, blocked milk ducts, breast engorgement pain, or mastitis. Our unit implements postpartum breast acupoint scraping to attenuate breast engorgement. We identified that nurses struggled to implement clinical care, with a completion rate of only 51.43%. The reasons for this were insufficient time, doubts about the effectiveness of the treatment, the location of acupoints being unclear, a lack of standard operating procedures, and insufficient tools. Based on decision-making matrix analysis, six corrective measures were implemented: reducing the number of caregivers, providing on-the-job education, providing breast molds for teaching, designing standard postpartum breast acupoint scraping techniques, creating videos of scraping techniques, and purchasing additional scraping tools. After the implementation of these measures, the rate of postpartum breast acupoint scraping completion by nurses increased from 51.43% to 97.14%, indicating the achievement of the project goal. This project improved the quality of postpartum breastfeeding care through the promotion of knowledge and skills regarding the traditional Chinese treatment of acupoint scraping.

1. Chiu, J. Y.,Gau, M. L.,Kuo, S. Y.,Chang, Y. H.,Kuo, S. C.,Tu, H. C.(2010).Effects of Gua-Sha therapy on breast engorgement: Arandomized controlled trial.The Journal of Nursing Research,18(1),1-10.
   連結：
2. Tang, L. C.,Tsai, C. S.,Tsai, C. H.(2007).Integrating complementary alternative medicine into nursing education in Taiwan.Journal of Medical Education,11(3),183-192.
   連結：
3. American Academy of Pediatrics(2000).Breastfeeding : Best for baby mother.American Academic of Pediatrics Newsletter,2(1),2-5.
4. 李琇蓉,林惠美,陳蓓蓓(2018)。運用按摩球減輕產後婦女乳房腫脹之成效。北市醫學雜誌，15(2)，49-57。
5. 馬素華(2005)。穴位按壓法於護理臨床實務之應用。護理雜誌，52(4)，5-10。
6. 張永賢,張曼玲,羅琦,蘇靖媛,陳光慧,陳慧珊,唐娜櫻,邱靜瑜,施欣欣,杜惠娟,王小喬,楊瓊芳,高宗桂(2019).中醫護理學概論.文京.
7. 郭吉助（2008，2 月 24 日）．健康與疾病，何謂 - 醫療行為．http://homepage.vghtpe.gov.tw/~ged/listn/listn_a122.htm
8. 陳嘉惠(2010)。南華大學。
9. 陳麗麗,王純娟,林君黛,張曼玲.實用中醫護理學.華杏.
10. 衛生福利部國民健康署（2019，8 月 21 日）．母乳哺育率推行現況，國健署呼籲落實母嬰親善措施．https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=506&pid=463