比較鼻部手術患者三種衛教方式之成本效益分析

An Analysis of the Cost-effectiveness of Three Educational Programs for Patients Undergoing Nasal Surgery

吳英旬(Ying-Hsun Wu)；賴妃珍(Fei-Chen Lai)；相青琪(Ching-Chi Hsiang)；魏婉華(Wan-Hua Wei)

成效 ； 衛教 ； 鼻部手術 ； effectiveness ； educational program ； nose surgery

The Changhua Journal of Medicine

6卷3期（2001 / 07 / 01）

174 - 183

繁體中文

背景：面對現今多變的環境，醫院管理必須重視護理人力成本，而應用衛教錄影帶可兼顧成本及品質。本院鼻部手術病人流動性很大，造成護理人員的工作負擔。而護理人員資歷、衛教講解技巧良莠不齊，可能遺漏應指導內容，故將鼻部手術後照護知識及技巧拍成衛教錄影帶。為探討其執行成效，故設計鼻部手術患者衛教方式成效探討之研究。 方法：本研究目的在比較使用錄影帶團體衛教、責任護士1對1床邊口頭衛教及專任衛教護理師現場團體衛教等三種方式之效果。樣本取自民國88.2.7～88.4.23間，某醫學中心行鼻部手術之住院病患共155位，其中l對l床邊口頭衛教組61名、現場團體衛教組46名、錄影帶團體衛教組48名。評價方法採多組前測後測設計，效果指標為成本、認知程度、自我照顧行為；研究工具為自擬式問卷及自製教具。 結果：研究結果顯示成本方面以錄影帶衛教最低（3元／每人次），其次是現場團體衛教（5元／人次），l對l口頭衛教最貴（39元／每人次）；效果方面三種衛教方式三組間之患者知識前後測得分差異情形未達統計上顯著水準，行為得分亦無顯著差異；即三種衛教方式之效果相同。 結論：在考量成本因素下，建議採用錄影帶衛教取代其他兩種衛教方式，以節省人力並減少臨床護理工作人員之負擔。

Background: In the changing healthcare system, nursing costs are of concern to hospital managers. Using videotapes to provide quality and cost effective patient education is a alternative to patient education by nurses and health educators. Though the hospital stay for a nose (ENT) surgery patient is very brief, such a patient's education is still an extra workload for nurses. The success of patient education can vary with the difficulty of the techniques and the extent of the nurse's experience, and sometimes important facts can be omitted inadvertently. Considering all the issues, we made a videotape demonstrating self-care knowledge and techniques for nose surgery patients. This study is to evaluate the effectiveness of this method of patient education. Method: A total of 155 hospitalized patients (from Feb.7, 1999 to Apr.23, 1999) of a medical center were recruited for this study and categorized into three groups including patients taught by videotape (48 patients), by a nurse or health educator (46 patients), and by one-to-one teaching by a nurse or health educator (61 patients). The three groups were pre- and post-tested to evaluate the effectiveness of cost, knowledge, and self-care behaviors. Results: The study results showed that video group teaching has the lowest cost (NT$ 3/person-time), one-to-one teaching is the most expensive (NT$ 39/person-time) and the cost of group teaching by a health educator is intermediate between the other two (NT$ 5/person-time). In terms of effectiveness, there was no significant difference among three groups. Conclusion: Based on the study results, we recommend that one-to-one teaching and group teaching by a nurse can be replaced by video group teaching providing health education for nose surgery patients.