提升血液腫瘤病房護理人員「情緒困擾溫度計」評估執行率改善方案

A Project for Improving the Execution Rate of Assessment on ＂Distress Thermometer＂ (DT) by Nurses in Wards of Hematology and Oncology

10.3966/102673012017092803007

詹瑞君(Jui-Chun Chan)；楊伊雯(Yi-Wen Yang)；唐婉如(Woung-Ru Tang)

護理人員 ； 情緒困擾溫度計 ； 第六個生命徵象 ； nurse ； distress thermometer ； the sixth vital signs

長庚護理

28卷3期（2017 / 09 / 01）

463 - 475

繁體中文

背景：為使癌症病人心理問題儘早受到篩檢及提供適切的照護，歐美各國已廣為推動第六個生命徵象「情緒困擾」的評估，而台灣各大醫學中心對情緒困擾的評估卻仍在起步階段。目的：本專案旨在了解北部某醫學中心血液腫瘤科病房護理人員，對「情緒困擾溫度計」（Distress Thermometer, DT）評估的執行情形，希望透過本專案提升其執行率。解決方法：透過現況分析發現護理人員的「DT」評估執行率低僅達20%。原因主要與對DT 評估使用不清楚、評估規定流程不清楚及缺少相關在職教育課程有關。專案組員依導因研擬可行之改善方案，如：增設DT 使用指導手冊、製作臨床情境示範影片（DVD）、和舉辦在職教育課程來提升護理人員對「DT」評估的認知和執行率。結果：經過9 個月的專案改善，血液腫瘤科病房護理人員對「DT」評估執行率由原先的20% 提升至94%，達成專案目標。結論：本專案的執行確實提升護理人員對DT 評估的臨床能力與應用，若能持續推動DT 篩檢並輔以合宜的介入措施，應對提升病人罹癌期間的心理安適有所助益。

Background: In order to detect the psychological issues of patients with cancer and provide appropriate care as soon as possible, the assessment on the sixth vital sign ＂emotional distress＂ has been widely promoted and implemented in Europe and the United States. However, Taiwan's major medical centers' emotional distress assessments is still in the infancy stage. Purpose: The purpose of this project was mainly focused on the execution of assessment on ＂Distress Thermometer (DT)＂ operated by nurses in wards of Hematology and oncology a certain medical center in the northern Taiwan, hopes to improve nurses' DT execution rate through this project. Method: The project group found that the execution rate of DT assessment was only 20%. The main causes were the failure to understand how to operate DT, unfamiliarity with assessment criterion, and lack of relevant in-service education courses. Therefore, we have developed the improvement plan according to the main causes, including adding DT user instruction manuals, producing clinical context demonstration videos (DVD), and holding in-service education courses to enhance the nurses' capacity and increase the DT assessment execution rate. Result: After implementation of the improvement plan for nine month, the execution rate of assessment on DT by Hematology and oncology nurses increased has increased from 20% to 94%, and the objective of the project was achieved. Conclusion: This project significantly enhance nurses' clinical ability and applications to assess DT was improved. If we can promote the DT screening continuously and take appropriate intervention simultaneously, are able to assist patients with easing emotional problems and enhancing the level of quality of care in clinical psychology.

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