建立食道癌病人空腸造瘻之臨床照護指引

Establishment of the Jejunostomy Clinical Care Guideline for Esophageal Cancer Patients

10.3966/168395442015061501004

鄒茵茵(Yin-Yin Tsou)；張聿仁(Yu-Jen Chang)；黃慧雯(Hui-Wen Huang)；童惠芳(Hui-Fang Tung)；白玉珠(Yu-Chu Pai)

食道癌 ； 空腸造瘻 ； 臨床照護指引 ； esophageal cancer ； jejunostomy ； clinical care guidline

腫瘤護理雜誌

15卷1期（2015 / 06 / 01）

25 - 38

繁體中文

食道癌病人常需依賴空腸造瘻術獲得足夠的營養，為有效控制合併症，建立空腸造瘻臨床護理指引是必要的。本研究目的藉由實證模式建立食道癌空腸造瘻之臨床護理指引。以三階段進行，階段一先行文獻查證，搜尋2001年至2012年系統性回顧文獻、隨機對照研究及臨床指引文獻共6篇，依評析結果萃取26項實證證據，建立食道癌空腸造瘻臨床護理指引草案；階段二邀請空腸造瘻照護專家進行2次專家焦點團體會議，藉由其專業觀點，最後修正照護指引30項；階段三以問卷調查23位專家及203位護理人員臨床護理指引之可行性。研究結果專家同意可行性為99.1%、護理人員同意可行性為98.1%，確認30項指引包含適應症和合併症4項、灌食前評估4項、灌食處置策略18項及造瘻口皮膚照護策略4項，建議等級Grade A19項、Grade B 11項。本研究所建立之臨床照護符合台灣文化，可應用於食道癌空腸造瘻術後病人，以提升空腸造瘻照護品質。

Esophageal cancer patients often need to rely on jejunostomy to obtain adequate nutrients. Therefore, a jejunostomy clinical guideline is essential so the nursing staff can properly maintain the nutritional status in these patients. The aim of this three-phase study was to establish a clinical guideline based on an evidence-based model. In the first phase, we conducted a comprehensive systematic literature review on clinical guidelines published between 2001 and 2012. Six studies met our criteria and were used in drafting a clinical care guideline of 26 items. In the second phase, two sessions of focus group seminar were held where twenty-three clinical experts from three districts (north, central, and south Taiwan) were invited to modify the draft which ended with 30 items. Finally, in the third phase, we conducted a questionnaire survey to evaluate the feasibility and received a rate of 99.1% from the 23 experts and 98.1% from the 203 nursing staff. The 30-item clinical guideline included 4 items in general principles, 4 in beforefeeding assessment, 18 interventions of jejunostomy feeding, and 4 for skin care. The scores of these items were grade A for 19 items and B for 11 items. This newly established care guideline is in alignment with local culture of Taiwan and can be implemented to improve the nursing care of esophageal cancer patients with jejunostomy.

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