提升腹部急症病人引流管自我照護正確率

Improving Drainage Tube Self-Care in Patients with Acute Abdominal Diseases

10.6386/CGN.202003_31(1).0006

蔡香薇(Hsiang-Wei Tsai)；郭貞嬋(Chen-Chan Kuo)；邱存梅(Tsun-Mei Chiu)；余沛瑀(Pei-Yu Yu)；林秋子(Chiu-Tzu Lin)

腹部急症 ； 引流管 ； 自我照護 ； emergency of abdominal diseases ； drainage tube ； self-care

長庚護理

31卷1期（2020 / 03 / 01）

62 - 76

繁體中文

腹部急症病人引流管留置通常會放置3－6個月，因此出院後仍需持續引流管照護，若出院返家未妥善處理，易增加感染風險導致再入院，使照護成本增加。2016年1－3月有6位因引流管滑脫重返急診、2位返家後引流管感染再入院；調查腹部急症病人執行引流管自我照護正確率僅62.3%，分析原因為護理人員執行腹部引流管照護衛教指導完整率低及照護認知率低、腹部急症病人表示引流管自我照護步驟及用物準備項目多且住院期間未主動認真學習；解決辦法為建立腹部急症病人引流管照護衛教指導標準作業流程並舉辦團體衛教暨技能訓練課程、製作引流管自我照護步驟圖卡、異常自我監控表及提供So Easy傷口護理包；專案結果腹部急症病人引流管自我照護正確率97.1%，建議臨床應藉由團體衛教活動增加病人學習引流管自我照護認知與技能訓練，進而提升專科護理照護品質。

Drainage tube usually remains in the body of patients with acute abdominal diseases for three to six months. Therefore, proper care of drainage tube is necessary after patients being discharged. Without appropriate care, the risk of infection will increase, which may lead to re-admission and higher cost of care. There were six patients returned to emergency room due to loosing drainage tube and two patients re-admitted because of infection from January to March in 2016. We found that patients with drainage tube remained, had poor self-care technique, with only 62.3% accurate. Further analysis revealed that possible reasons included incomplete education of drainage care from nurses, lack of awareness of drainage care, poor compliance of caring procedures, and inadequate learning during hospitalization. The improvement project included establishing a standardized operation procedure, offering a self-care chart and an abnormality self-monitoring table, organizing group education and skills training courses, and providing so-easy wound care kits. The result of this project showed that the accuracy of self-care increased to 97.1% The project suggests that group education activities can improve the quality of nursing care by increasing patient's willingness to learn.

1. 蔡素玲, S. L.,陳素里, S. L.,林秀秀, X. X.(2015)。提升護理人員對開放性傷口床照護之正確率。領導護理，16(3)，88-99。
   連結：
2. Farrel. R.,Ffnmrcsi. P. H.(2017).Nurse’s experience of caring for patient’s in the community after discharge with an interventional radiology drain in ireland: a qualitative study.journal of radiology nursing,36(4),228-235.
3. Ke, L.,Li, J.,Hu, P.,Wang, L.,Chen, H.(2016).Percutaneous catheter drainage in infected pancreatitis necrosis: A systematic review.Indian Journal Surgery,78(3),221-228.
4. Keller, J. M.(1983).Motivational design of instruction.Instructional design theories and models: An overview of their current status,384-434.
5. Myra, C.,Laura, I.,James, F. B.,Nancy, M. A.(2017).Nurse and patient factors that influence nursing time in chest tube management early after open heart surgery: A descriptive, correlational study.Intensive and Critical Care Nursing,42,116-121.
6. Odom, F. J.,Wesmiller, S.(2017).Managing symptoms: Enhancing Patients self-management knowledge and skills for surgical recovery.Seminars in Oncology Nursing,33(1),52-60.
7. Podda, M.,Polignano, F. M.,Luhmann, A.,Wilson, M. S.,Kulli, C.,Tait, I. S.(2016).Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis.Surgical Endoscopy,30(3),845-861.
8. Vaismoradi, M.,Salsali, M.,Marc, P.(2011).Patient safety: nursing students’ perspectives and the role of nursing education to provide safe care.International Nursing Review,58,434-442.
9. 王拔群, P.,翁惠瑛, C.,石崇良, C. L.(2014)。台灣病人安全通報系統─中心靜脈導管相關事件分析。輔仁醫學期刊，15(12)，37-50。
10. 台灣病人安全資訊網(2019，04月22日)．107-108年度醫院醫療品質及病人安全工作目標．取自http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=655635445640513543[Taiwan Patient Safety Net (2019, April 22). 107-108 Medical and hospital quality and Patient Safety Annual Goals. Retrieved from http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=655635445640513543]
11. 洪慧君, H. J.,遲毓芬, Z. F.,連金延, J. Y.(2013)。提升腹部手術病人下床活動管路照護之完整性。榮總護理，30(2)，206-213。
12. 許莉宛, L. W.,朱婉君, Y. J.,林美娟, M. J.(2013)。提升出院病人傷口自我照護正確率之專案。安泰醫護雜誌，20(1)，37-52。
13. 郭緒東, X. D.,張天長, T. C.(2012)。外傷傷口癒合與慢性傷口。家庭醫學與基層醫療，27(12)，414-421。
14. 陳莉卿, L. Q.,鄭之勛, Z. X.(2014)。重視管路事件，維護病人安全。醫療品質，5(2)，1-4。
15. 陳徵維, Z. G,王美惠, M. H.(2014)。護理人員對於病人安全認知之文獻探討。健康與建築雜誌，1(4)，9-14。
16. 蔡曉婷, X. T,周汎澔, P. J.(2012)。多媒體護理指導緩解冠狀動脈成形術後心肌梗塞病患焦慮及疾病不確定感之成效。護理雜誌，59(4)，43-53。

1. 羅心怡,鄭青青,張瑋,林育嘉(2022)。運用創造思考教學提升二年期護理師腹部引流管照護完整率。護理雜誌，69(5)，86-95。
2. 羅苡筑,陳俞君,莊佩華(2023)。照護一位乏特氏壺腹癌術後引發膿胸病人之護理經驗。彰化護理，30(3)，144-156。