提升腦中風病房護理人員吞嚥訓練執行率之專案

A Project for Improving the Implementation Rate of Swallow Training to Nursing Staff in the Stroke Patients' Ward

10.29494/LN.201906_20(2).0008

林玉菜(Yu-Tsai Lin)；鍾宛臻(Wan-Chen Chung)；林宜蓁(Yi-Chen Lin)；陳玉未(Yu-Wei Chen)；陳芝文(Chih-Wen Chen)

腦中風 ； 吞嚥困難 ； 吞嚥訓練 ； stroke ； difficulty swallowing ； swallow training

領導護理

20卷2期（2019 / 06 / 01）

97 - 110

繁體中文

腦中風病人常見的吞嚥障礙為無法吞口水、嗆咳及吞嚥反射延遲等，進食是營養攝取必要的能力，若無法由口進食，病人將面臨挫折感、社交活動減少及社交隔離。臨床發現經語言治療師吞嚥訓練的病人鼻胃管拔除率極高，但單位護理人員未重視且缺乏吞嚥訓練之規範，導致鼻胃管拔除率低，主要問題為吞嚥功能評估知識與技巧不足、缺乏吞嚥訓練查檢表、缺乏衛教指導輔助工具、缺乏完整的吞嚥訓練標準作業流程。本專案目的在提昇腦中風病房護理人員吞嚥訓練執行率達80％，擬定解決方案為教育訓練、製訂吞嚥訓練查檢表、修訂吞嚥訓練標準作業流程、製作指導手冊與示範光碟，專案進行後護理人員吞嚥訓練執行率由7％提昇至82％，達本專案之目的，經落實吞嚥訓練以改善病人的吞嚥能力、減少鼻胃管留置時間、讓病人儘早回歸由口進食的能力，進而提升腦中風病人生活品質。

Dysphagia is a common symptom among stroke patients. If a stroke patient has dysphagia, he may experience pain when he swallows, possibly choking or coughing, and chances of delayed swallowing reflex. Swallow is an essential ability of nutrient intake. Without the ability to swallow, patients face a sense of frustration, their social activities reduces, and they become socially isolated. It was found that patients' nasogastric tube extraction rate is higher when the swallow training is provided by a speech and language therapist than a nursing staff. This is predominantly due to nurses' insufficient knowledge and skills in swallow training, undersupplied swallow training checklist, inadequacy health education, shortfall auxiliary tools, and absence of auditing mechanisms. This project aimed to intensify the nurse's implementation rate of swallow training for stroke patients to 80%. The proposed improving methods included educational training for staffs, constructing swallow training checklist, establishing swallow training standard procedures, and publishing swallow training guideline and demonstration DVD. After the implementation of the project, the nurses' implementation rate of swallow training for stroke patients increased from 7% to 82%, which accomplished the project's intention. The patients' swallow ability was progressed by improving the implementation rate of swallow training, and nasogastric tube retention time was hence reduced. As stroke patients' ability of oral intake improves, it also enhances their quality of life.

1. Martino, R.,Silver, F.,Teasell, R.,Bayley, M.,Nicholson, G.,Streiner, D. L.,Diamant, N. E.(2009).The toronto bedside swallowing screening test (TOR-BSST) development and validation of a dysphagia screening tool for patients with stroke.Stroke,40(2),555-561.
2. Perry, L.,Hamilton, S.,Williams, J.,Jones, S.(2013).Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes.Worldviews on Evidence-Based Nursing,10(1),17-40.
3. Sura, L.,Madhavan, A.,Carnaby, G.,Crary, M. A.(2012).Dysphagia in the elderly: management and nutritional considerations.Clinical Interventions In Aging,7,287-298.
4. Takahata, H..,Tsutsumi, K.,Baba, H.,Nagata, I.,Yonekura, M.(2011).Early intervention to promote oral feeding in patients with intracerebral hemorrhage: a retrospective cohort study.BMC Neurology,116
5. 于博芮,程瓊嬅(2011)。台大醫院腦中風中心成立之成效。領導護理，12(2)，2-7。
6. 李怡珍,顏欽堉,林玫吟,于錫倩,張敏德(2014)。探討口腔癌術後早期介入吞嚥訓練及監測進食安全之成效及影響因素。臺灣口腔顎面外科學會雜誌，25(1)，1-7。
7. 陳妙言(2013)。台北市，國立陽明大學。
8. 陳妙言,林麗嬋(2010)。吞嚥障礙之概念分析。護理雜誌，57(1)，100-105。
9. 陳偉鵬,郭碧照,謝惠玲,葉淑惠,胡順江,袁素娟,廖玟君,翁碩駿(2016)。吞嚥困難。臨床症狀護理，台北市:
10. 富田,李紹懷（譯 ）(2011).吞嚥障礙者必讀讓進食與吞嚥順暢的日常生活照護.台北:合記.
11. 童蔘美,魏綸緯,林月娥,何咏涵(2013)。提升護理人員執行腦中風病人吞嚥訓練完整性。志為護理，12(6)，85-97。
12. 黃光雨(2011)。急性腦中風吞嚥困難篩檢。腦中風會訊，18(1)，9-10。
13. 衛生福利部 ( 2017,12 月 31 日 ) , 105 年國人死因統計結果 , 取自 https://www.mohw.gov.tw/cp-16- 33598-1.html
14. 盧采臻,張麟鳳,洪蘆妍,彭淑苹(2015)。護理人員協助執行腦中風病人吞嚥訓練之指引及現況。榮總護理，32(2)，202-207。