提升頭頸癌病人自我吞嚥訓練執行率

Effortful Swallowing Training for Patients with Head and Neck Cancer

10.6880/TJON.201912_19(2).06

卓美妤(Mei-Yu Cho)；王妍懿(Yen-Yee Wang)；黃正儀(Chen-Yi Hung)；李淑瓊(Shu-Chiung Lee)

頭頸癌 ； 吞嚥困難 ； 吞嚥訓練 ； 鼻胃管 ； head and neck cancer ； dysphagia ； swallowing training ； nasogastric tube

腫瘤護理雜誌

19卷2期（2019 / 12 / 01）

77 - 90

繁體中文

頭頸癌病人因腫瘤及治療因素常造成吞嚥困難須以鼻胃管進食，增加照護負擔，亦可能導致延遲性吞嚥障礙，2016年1～3月本單位因吞嚥困難放置鼻胃管達51.1%，僅11人於住院期間有自我吞嚥訓練，病人自我吞嚥訓練執行率47.8%。分析執行率低原因：病人對吞嚥訓練認知不足、護理人員未常規執行吞嚥困難篩檢與訓練、護理人員吞嚥相關認知不足。以跨團隊合作方式舉辦在職教育、製作數位教材、擬定護理指導單張、標準化篩檢表及作業流程後，病人自我吞嚥訓練執行率93.8%，達目標90%以上，且吞嚥訓練轉介率、鼻胃管移除率、護理人員吞嚥訓練認知均有提升，建議未來應落實以跨領域團隊合作方式，針對頭頸癌病人進行吞嚥困難篩檢與訓練，以提升鼻胃管移除率，恢復正常進食。

Patients with head and neck cancer suffer from dysphagia associated with tumor invasion or treatment complication. They need to eat through nasogastric tube, which increases the burden of caregivers and causes delayed dysphagia. From January to March 2016, the placement rate of nasogastric tube owing to difficulty in swallowing was 51.1%, the patient effortful swallowing training rate was 47.8%, where only 11 people underwent effortful swallowing training during hospitalization. Our analysis showed that patients lack information on swallowing training, the swallowing screening and training was not a daily routine for the nurses, and the nursing staffs lack the education of swallowing. After a cross-disciplinary collaboration of on-the-job education with digital teaching materials, nursing instruction leaflets, standardized swallowing screening forms, and operating procedures, the effortful swallowing training implementation rate was increased to 93.8% reaching the goal of 90%. In the meanwhile, the swallowing training referral rate, the nasogastric tube removal rate, and the knowledge of swallowing training in the nursing staffs have all improved. It is recommended that a collaborative practice of swallowing screening and training should be implemented in patients with head and neck cancer to improve the removal rate of nasogastric tube and restore normal eating.

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