提升外科加護病房腎臟移植照護完整性之改善專案

A Project for Improving the Care Completion Rate of Caring Kidney Transplant Patients in a Surgical Intensive Care Unit

陳湘慈(Hsiang-Tzu Chen)；曹家甄(Chia-Chen Tsao)；葉宜芳(Yi-Fang Yeh)；黃文萍(Wen-Ping Huang)；湯婉孏(Wan-Lan Tang)

重症照護 ； 腎移植 ； 照護指引 ； care guidelines ； intensive care unit ； kidney transplantation

志為護理-慈濟護理雜誌

19卷5期（2020 / 10 / 01）

67 - 83

繁體中文

本專案目的提升外科加護病房腎臟移植病人照護完整率之改善專案，因本院腎臟移植術後照顧規範不完整，目前只有移植術後手冊，經專案小組臨床觀察分析後發現原因有：教育訓練不完整、缺乏腎臟移植術後護理標準作業規範、用藥注意事項認知不足、傷口引流管照護認知不足、醫療處理認知不足、對衛材、儀器準備標準不一致、人員照護實務經驗不足、缺乏稽核制度。經施行以下策略：舉辦腎臟移植術後照護在職教育及情境模擬課程、製訂腎臟移植術後照護指引手冊、製訂腎臟移植病室用物查檢表、製訂腎臟移植術後護理正確性監控表、規劃腎臟移植術後護理正確性監控人員，實施後單位人員對腎臟移植病人照護完整率由75.1%提升至98.0%，已達到專案目的。

This project aims to raise the overall care of kidney transplant patients in a surgical intensive care unit (ICU). Currently, we have related pamphlets and care system that needs improvement as the project team found the following defects: incomplete training, lack of operating standards regarding the postoperative nursing care for kidney transplant patients, lack of understanding of safe medication use, insufficient knowledge of wound care and medical treatments, inconsistent standards of sanitary materials and devices, and lack of experienced nurses. To improve the overall care of kidney transplant patients, strategies were implemented, including providing on-the-job training for healthcare professionals on post-renal transplant care and scenario-based lessons, following the kidney transplantation care guidelines, verifying a checklist of operating room devices used in kidney transplantation, performing correct postoperative care, and assigning a supervisor to oversee that proper care was given to the patients. As a result, the care completion rate of kidney transplant patients increased from 75.1% to 98%.

1. Nehring, W. M.,Lashley, F. R.(2009).Nursing simulation: A review of the past 40 years.Simulation & Gaming,40(4),528-552.
2. Pan, S. M.(1993).A study of hospital nurses’ attitudes toward continuing education in Kaohsiung City.Kaohsiung Journal of Medical Sciences,9(2),76-89.
3. Turner, P.(1991).Benefits and costs of continuing nursing education: AN analytical survey.Journal of Continuing Education in Nursing,22(3),104-108.
4. 王本正,周信甫,張郁政(2014)。銀髮族醫療照護機構之流程再造。福祉科技與服務管理學，2(2)，129-140。
5. 吳金玲,林怡秀,黃小萍,徐玲蕙,徐旭香(2012)。兒科加護病房病人放置葉克膜護理流程完整性之改善方案。護理雜誌，59(6)，65-72。
6. 呂菁萍,林淑浣,梁亞文,張雅琳(2008)。影響護理人員對於護理照護活動認知差異之相關性分析。澄清醫護管理雜誌，4(1)，16-23。
7. 周桂君,李明哲(2014)。腎臟移植的醫療照護現況。護理雜誌，61(4)，15-20。
8. 徐盈真,林妍雯,張瓊櫻(2010)。照顧一位接受體外循環維生系統治療之照護經驗。高雄護理雜誌，27(1)，84-95。
9. 財團法人器官捐贈移植登錄中心(2015)．即時統計．取自https://-www.-to-rsc.org.tw/index.jsp/
10. 莊嫺儒,葉芳枝(2008)。照護一位接受腎臟移植患者之護理經驗。中山醫學雜誌，19(1)，113-126。
11. 黃淑芸,陳夏蓮,胡庭禎(2012)。探討加護病房護理人員應具備之臨床能力。榮總護理，29(3)，243-252。
12. 衛生福利部中央健康保險署(2013，1月12日)．熟能生巧：腎臟移植手術量大之醫院病人存活率較佳健保局建議器官移植手術應該採重點式發展 ．取自http://www.nhi.gov.tw/information/NewsDetail.aspx?menu=9&menu_id=544&-No=1056
13. 嚴玉華(2004)。醫院護理人員在職教育訓練與專業能力進階制度之探討。安泰醫護雜誌，10(2)，70-76。