血液透析護理人員執行高血磷護理指導完整性之改善方案

Promoting the Nursing Instruction for Hemodialysis Patients with Hyperphosphatemia

10.29494/LN.201803_19(1).0008

葉淑敏(Shu-Min Yeh)；林育如(Yu-Ju Lin)；吳莒瑛(Chu-Ying Wu)；徐紫娟(Tzu-Chuan Hsu)；張玉婷(Yu-Ting Chang)

血液透析 ； 高血磷 ； 護理指導 ； hemodialysis ； hyperphosphatemia ； nursing instruction

領導護理

19卷1期（2018 / 03 / 01）

91 - 104

繁體中文

一致及完整的高血磷護理指導，有助於協助透析病人血清磷值之控制。經現況分析，發現因護理人員對高血磷認知不足、缺乏相關在職教育、護理指導工具不足、缺乏護理指導標準規範與稽核制度，導致單位護理人員執行透析病人高血磷護理指導之完整率僅53.1%。經實施改善方案：舉辦在職教育、製作護理指導工具、建立護理指導標準作業規範、舉辦情境模擬演練、製作護理指導學習影片、建立個案護理師制度、進行護理指導稽核。高血磷護理指導完整性由53.1%提升至96.5%；護理師對高血磷之認知由61.5%提升到96.7%；門診透析病人血清磷≧6.0mg/dl之人數，由30.7%降至19.3%，顯示落實護理指導有助於降低病患之血磷數值。

Consistent and comprehensive nursing instruction regarding prevention of hyperphosphatemia facilitates patients who have underwent hemodialysis. Analysis of the conditions revealed that nurses attained a 53.1% completion rate in nursing instructions due to insufficient knowledge, lack of continuous education, inadequate nursing instruction tools and materials, a lack of standard operating procedures (SOPs), and an audit/review system for relevant nursing instructions. Strategies for improvement were proposed as follows: providing continuous education regarding hyperphosphotemia, creating nursing instruction tools and materials, establishing nursing instruction SOPs, implementing practical simulation training, creating nursing instruction films, developing a case nurse system and reviewing nursing instructions . After implementing the strategies, the completeness Of nursing instructions increased from 53.1% to 96.5%. The percentage of nurses knowledgeable of hyperphosphatemia increased from 61.5% to 96.7%, with the percentage of outpatients with a serum phosphate level of 6.0 mg/dL or higher reduced from 30.7% to 19.3%, revealing that the improved and completed nursing instructions were conducive to reducing the serum phosphate levels of hemodialysis patients.

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