提升護理人員執行肝臟移植術後衛教完整率

Improving Nursing Instruction Completion Rate of Post Liver Transplantation for Nurses

10.6692/KJN.202304_40(1).0004

謝菁怡(Ching-Yi Hseh)；陳雅玲(Ya-Ling Chen)；謝郁瑩(Yu-Ying Hsieh)；林采蓉(Tsai Rung Lin)

肝臟移植 ； 護理指導 ； 多媒體工具 ； Liver transplantation ； nursing instruction ； multimedia teaching tools

高雄護理雜誌

40卷1期（2023 / 04 / 01）

41 - 53

繁體中文;英文

肝臟移植手術病人之衛教，關乎病人術後照護的品質。專案病房曾接獲移植病人出院後來電諮詢有關免疫抑制劑遺漏服用及無法判斷排斥等問題，顯示護理師出院前居家照護衛教有改善空間，故激發此專案改善動機。經調查發現護理指導完整率低的原因包括：肝臟移植護理在職教育課程內容不完善、衛教不一致、衛教工具不完善、無衛教查檢表及衛教稽核制度。專案小組擬定策略包括：舉辦完整的移植照護教育課程、建立衛教查檢表及衛教稽核制度、製作多媒體電子書及藥物圖識卡QR Code等提升衛教指導完整率。結果肝臟移植術後護理衛教完整率由47.9%提升至97.1%。期望藉此專案，提供肝移植醫護人員術後照護的參考，提升病人自我照護能力，以減少病人術後併發症發生，增進器官移植照護品質。

Patient education considering liver transplant care is a critical issue for the quality of a patient's life. This project was motivated by the fact that nurses had received calls from discharged patients asking about how to deal with missed immunosuppressive drugs and inability to determine rejection, showing that the quality of patient education needed to be improved. Factors of the low completion rate were inadequate contents of nursing education, without a working checklist and a quality auditing policy; on the other hand, inconsistent patient education by nurses and poor patient education materials were also found. The task force organized a complete transplant care education program while establishing a patient education checklist and auditing system. Multimedia e-books and QR codes for medication identification cards were also created for patients and families. Ultimately, the completion rate of post-transplant care patient education increased from 47.9% to 97.1%. This project serves as a reference for medical staff to improve quality of patient education, to reduce the occurrence of post-operative complications, and upgrade the quality of organ transplant care.

1. 江懿真、邱明睿、蕭雅云、劉淑倩(2016)．提升肝臟移植術後病人用藥指導之完整性．志為護理，15(6)，66-77。
   連結：
2. 劉淑倩、黃芷誼、李秋琴、胡雅娟(2010)．肝臟移植手術後護理指導之改善專案．長庚護理，21(3)，323-334。https://doi.org/10.6386 /CGN.201009_21(3).0006
   連結：
3. 衛生福利部國民健康署(2020)．109年十大死因統計 ，https://dep.mohw.gov.tw/dos/np-1776-113.html
   連結：
4. 衛生福利部國民健康署(2020)．肝病簡介 ，https://www.hpa.gov. tw/Pages/Detail.aspx?nodeid=616&pid=1128
   連結：
5. 魏米秀、張美娟、謝至鎠、尤瑞鴻、Jürgen M. Pelikan、王英偉(2018)．健康識能機構實務指引．台北：衛生福利部國民健康署。
   連結：
6. Dogan, N., Hüsing-Kabar, A., Schmidt, H. H., Cicinnati, V. R., Beckebaum, S., & Kabar, I. (2018). Acute allograft rejection in liver transplant recipients: incidence, risk factors, treatment success, and impact on graft failure. Journal of International Medical Research, 46(9), 3979-3990. https://doi.org/gg9bd2
   連結：
7. Dols, J. D., Chargualaf, K. A., Gordon, A., Pomerleau, T., Mendoza, A., Schwarzbach, C., & Gonzalez, M. (2020). Relationship of nurse-led education interventions to liver transplant early readmission. Progress in Transplantation, 30(2), 88-94. https://doi.org/gwsr
   連結：
8. Elaine, W., Betty, F., Elisa, K., & Haley, B. (2018). Nurse communication challenges with Heath Literacy support. Clinical Journal of Oncology Nursing, 22(1), 53-61. https://doi.org/fc3m
   連結：
9. Ebraheim, M. N., & Barakat, A. H. A. (2018). Health needs management program and compliance with Therapeutic Regimen among postoperative liver transplant recipients. Egyptian Journal of Health Care, 9(1), 221-242. https://doi.org/gs6d
   連結：
10. Millson, C., Considine, A., Cramp, M. E., Holt, A., Hubscher, S., Hutchinson, J., Jones, K., Leithead, J., Masson, S., & Menon, K. (2020). Adult liver transplantation: UK clinical guideline-part 2: surgery and post-operation. Frontline gastroenterology, 11(5), 385-396. http://dx.doi.org/10.1136/flgastro-2019-101216
    連結：
11. Negreiros, F. D. D. S., Pequeno, A. M. C., Garcia, J. H. P., Aguiar, M. I. F. D., Moreira, T. R., & Flor, M. J. N. (2017). Multi-professional team's perception of nurses' competences in liver transplantations. Revista brasileira de enfermagem, 70(2), 242-248. https://doi.org/gs6f
    連結：
12. Yun, J. S., Lim, K. C., Jeong, J. S., Ha, H. S., Hong, J. J., Lee, S. H., Lee, Y. K., Kim, Y. H. & Hwang, S. (2017). Development of pre-discharge group education program for liver transplant patients. The Journal of the Korean Society for Transplantation, 31(1), 34-42. https://doi.org/gs6g
    連結：