以整合性照護模式改善COVID-19臨床照護負荷

Using Integrated Care Model to Improve Clinical Care and Workload for Patients with COVID-19

10.6530/YYN.202207_16(2).0008

陳美慧(Mei-Hui Chen)；蔡欣妤(Sin-Yu Tasi)；林麗華(Li-Hua Lin)；李麗珠(Li-Chu Lee)

轉型 ； COVID-19專責病房 ； 護理工作負擔 ； 跨團隊照護 ； transform ； quarantine ward of COVID-19 ； nursing workload ； interprofessional practice

源遠護理

16卷2期（2022 / 07 / 01）

58 - 66

繁體中文

2021年5月台灣爆發本土COVID-19社區感染，因擴展快速造成醫療照護量能緊繃，原專責病房無法承載爆增病患，本單位臨危受命由腦中風病房轉型、歷經三天整備開始收治。因病況變化快、重症及共病患者多，不僅增加工作壓力負荷並影響臨床照護作業滿意度，故引發專案改善動機，經現況分析後確立主要問題：（一）護理作業模式未符合臨床現況需求；（二）個案多樣化與耗時照顧；（三）感染性垃圾量暴增，影響環境安全。經改善策略，以整合護理照護模式與分區配置人力、延展通訊平台服務、相關科部室提供醫療照護、設備與資源、跨團隊協助共病者之照護、提供人員關懷與支持及降低防護裝備耗用量，工作滿意度由改善前72％提升至86.1％、照顧病人負擔的壓力總分從1.64降為0.90分、垃圾減量達36.6％。因疫情仍具挑戰性，本次轉型經歷可提供其他醫院未來面臨相同情況時參考。

Taiwan has entered the community transmission stage of COVID-19 in May 2021. This pandemic rapidly spread resulted in an unprecedented strain on healthcare professionals and led to the collapse of the medical capacity. The initial quarantine ward could hardly accommodate and ingest the overwhelming demand for medical care. Our unit was urgently assigned to transform from the stroke unit into a dedicated isolation ward and soon new patients were admitted following integrated planning three days later. However, the froneline nurses faced the most complicated challenges, including rapid changes in the various condition, the large numbers of critically ill patients and comorbidities, which not only increased nursing workload and pressure, but it also affected the satisfaction of clinical care. Therefore, the motivation for project improvement was triggered. After analysis of the current situation, the main problems have been discovered: (1) the nursing model did not match the needs of the clinical situation; (2) the diverse condition and time-consuming care were the characteristics of COVID-19 cases (3) The amount of contaminated medical waste increased sharply and polluted the environmental safety. Through the improvement strategies, we have integrated the nursing care model, district allocation of manpower, expanded instant messaging software functions, relevant departments offered assistance with measures and resources, transdisciplinary practice for cases with comorbidities, provided staff support, reduced consumption of personal protective equipment and then job satisfaction increased from 72% to 86.1%, stress score dropped from 1.64 to 0.90, and waste reduction reached 36.6%. Despite the challenges of the COVID-19 pandemic, this transition experience could be a learning platform for hospitals to take as a reference.

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