提升護理人員執行拔管後病人吞嚥照護完整性

Improving the Integrity of Nursing Staff's Swallowing Care for Patients After Extubation

王鈺幀(Yu-Chen Wang)；林孝安(Hsiao-An Lin)；吳宜臻(Yi-Chen Wu)；賴敏芳(Min-Fang Lai)

拔管後吞嚥困難 ； 吞嚥評估 ； 吞嚥訓練 ； post-extubation dysphagia ； swallowing assessment ； swallowing training

志為護理-慈濟護理雜誌

23卷4期（2024 / 08 / 01）

63 - 75

繁體中文;英文

插管病人因氣管內管長期壓迫咽喉，使喉部潰瘍或喉返神經麻痺，導致吞嚥效率降低，拔管後應盡早吞嚥評估、口腔復健運動，強化吞嚥肌力及反射，以達進食安全。經現況分析確立，護理人員執行拔管後病人吞嚥照護完整性34.3％，原因為護理人員吞嚥照護認知55％；評估表不適用拔管病人；吞嚥照護流程不完整；缺乏拔管後病人吞嚥照護指引及評估工具，藉由修訂吞嚥訓練評估表及吞嚥照護流程圖，製作吞嚥評估工具包、順吞不卡喉運動影片及吞嚥照護五步曲，舉辦吞嚥照護教育課程等改善措施，經專案實施後，護理人員執行吞嚥照護完整性由34.3％提升至92.3％，吞嚥照護認知正確性由55％提升至95.3％，達專案目標以維護病人安全提升護理品質。

In patients with intubation, the endotracheal tube oppresses the throat for a long time, causing laryngeal ulcers or paralysis of the recurrent laryngeal nerve, resulting in reduced swallowing efficiency. After extubation, evaluation of swallowing and oral rehabilitation exercises should be performed as soon as possible to strengthen swallowing muscle strength and reflex, so as to achieve safe eating. Based on the analysis of the current practices, it was established that the completeness of swallowing care performed by nursing staff in extubated patients is 34.3%. Contributing reasons include: the nursing staff's swallowing care cognition is 55%; the in-hospital evaluation form is not applicable; the swallowing care process is incomplete; there is no swallowing care guide and unified assessment tool for patients after extubation. In order to improve current practice, the following steps were taken: revising the swallowing training evaluation form and swallowing care flow chart; the production of swallowing assessment kits and oral rehabilitation exercise videos covering the five steps of swallowing care; and holding educational courses on swallowing care. After the implementation of the project, the completeness of swallowing care performed by nursing staff increased from 34.3% to 92.3%. The cognitive accuracy increased from 55% to 95.3%, thus reaching the project goal to maintain patient safety and improve nursing quality.