以實證護理提升護理人員執行腦中風病人吞嚥評估之精準度

Applying Evidence-based Nursing for Nurses to Improve the Accuracy of Swallowing Assessment in Stroke Patients

10.3966/102673012017092803004

莊情惠(Ching-Hui Chuang)；陳柏成(Po Cheng Chen)；梁秋萍(Chau-Peng Leong)；林淞坊(Sung-Fang Lin)

實證護理 ； 腦中風 ； 吞嚥評估 ； evidence-based nursing ； stroke ； swallowing assessment

長庚護理

28卷3期（2017 / 09 / 01）

426 - 438

繁體中文

背景：吞嚥評估是護理人員照護腦中風病人很重要的能力，復健科病房2014 年腦中風病人併發吸入性肺炎發生率為2.59‰。目的：專案主旨為提升護理人員執行腦中風病人吞嚥評估之精確度。方法：現況發現護理人員之吞嚥評估認知正確率42.7% 與護理人員之吞嚥評估執行精確度為4.75%。專案內容包括實施腦中風病人吞嚥評估實證文獻資料查詢，訂定吞嚥評估實施流程、製作吞嚥評估實施標準、舉辦吞嚥評估在職教育課程與操作一致性稽核。結果：經專案改善後，護理人員之吞嚥評估認知正確率由42.7% 提高至100%、護理人員對吞嚥評估執行精確度由4.75% 提高至100%，腦中風病人併發吸入性肺炎發生率由2.59‰下降至1.36‰。結論：護理人員可應用實證護理於臨床工作中，以提升腦中風病人吞嚥評估之精確度，最終能造福腦中風吞嚥困難病人，也能提升護理專業形象與專業能力。

Background: The ability of nursing staff to determine stroke deglutition disorders is important in care of stroke patients. The incidence rate in 2014 had revealed that aspiration pneumonia among patients with stroke was 2.59‰ in the rehabilitation ward. Purpose: This study aimed to increase diagnostic accuracy of stroke deglutition disorders among nursing staff in stroke care. Method: An investigation revealed that the knowledge of swallowing assessment among nursing staff was 42.7%, and the diagnostic accuracy of stroke deglutition disorders made by nursing staff was 4.75%. Solutions included query empirical literature, revised the policy for standard care for swallowing assessment, procedures, provided continuing education courses regarding swallowing assessment and audited the operational consistency. Results: After implementing strategies for these projects. Nursing staffs' knowledge of swallowing assessment improved from 42.7% to 100%. The diagnostic accuracy of stroke deglutition disorders made by nursing staff increased from 4.75% to 100%, and the incidence of aspiration pneumonia among patients with strokedecreased from 2.59‰ to 1.36‰. Conclusion: By applying evidence-based nursing to clinical practice, nursing staff can increase diagnostic accuracy of stroke deglutition disorders, patients with stroke deglutition disorders can be treated promptly and effectively, and the professional image as well as ability of nursing staff can also be boosted.

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