創建醫院「酒精依賴個案戒酒照護流程」計劃

Developing a Clinical Practice Guidelines for Alcohol Dependence Patients

10.29442/HPRP.202107_4(2).0004

曾郁心(Yu-Hsin, Tseng)；張惠禎(Hui-Chen, Chang)；林湘庭(Hsiang-Ting, Lin)；邱昕怡(Hsin- I, Chiu)；賴宜芳(I-Fang, Lai)；彭彥領(Yen- Ling, Peng)

酒精依賴 ； 戒酒 ； 促進健康 ； alcohol dependence ； abstinence from alcohol ； health promotion

健康促進研究與實務

4卷2期（2021 / 07 / 01）

25 - 32

繁體中文

目的：酒精濫用不僅引發疾病及死亡，更是影響家庭、醫療成本和社會問題的主要來源。為提升酒癮病人的照護品質，本研究透過與精神科、社會工作室的跨團隊合作，訂定「酒精依賴個案戒酒照護流程」的臨床照護指引，以幫助病人成功戒酒。方法：本研究包含兩個階段，第一階段透過資料分析、問卷調查及質性訪談進行需求評估，以了解護理人員提供戒酒照護的意願、病人及家屬對於戒酒之需求；第二階段運用特性要因圖和決策矩陣分析找出原因，並透過跨團隊討論照護流程及對策，再以會診率及回診率評估此臨床照護指引之成效。結果：第一階段的研究結果發現護理師對酒精依賴照護認知低，且趨向被動面對照顧此類病人，護理人員之間專業知識來源或經驗的分享不足夠；病人方面戒酒意願高，但行動力低；家屬的支持度高，但協助的資源不足。依據第一階段調查結果，第二階段除了提供護理人員酒精依賴病人照護之教育訓練、病人團體衛教，也透過跨團隊合作發展酒精依賴個案照護流程、建立友善環境及輔助工具，提供病人戒酒服務。結果發現介入後護理人員對酒精依賴照護認知率由51%提升至100%，且護理人員對酒精依賴病人照護作業執行率由0 %，提升至100%。此外，酒精依賴病人會診精神科比率由12.9%提升至30.3%，且回診精神科之比率，由0 %提升至29.4 %。結論：本研究有效提升護理人員照護認知，且戒酒照護流程作業能有效提升酒精依賴病人精神科會診率及回診率，進而提升病房安全及專業照護品質。

Objectives: Alcohol abuse not only caused diseases and increased the mortality rate, but also increased domestic issues, medical costs and social problems. To enhance the quality of care among alcoholic patients, we cooperated with psychiatrist and social workers to develop a clinical practice guideline which help alcohol dependent patient to quit drinking. Methods: There were two stages in our study. First, we conducted a need assessment by data analysis, questionnaire and interview to know our crews' intention of caring alcoholic patients and patients' needs for quitting drinking. Second, we used cause and effect diagram and decision matrix to summarize the causes, and developed the clinical practice guideline which was evaluated by consultant rate and return rate. Results: In the first stage, we found nurses had low awareness and intention of caring alcohol dependence patients, and they didn't have much professional knowledge and experience sharing. Patients had high intention to abstain from alcohol, but not for actions. In addition, patients' family were willing to help, but they didn't have enough resources. After the first stage, we not only conducted the nurses' training about caring alcohol dependence patients, group health education for patients, but also developed the guideline to care these patients, and constructed a supporting environment. After the intervention, we found our nurses improved their knowledge of caring alcohol dependence patients from 51% to 100%. It also increased the consultant rate to psychiatry from 12.9% to 30.3%, and the return rate from 0% to 29.4%. Conclusion: These strategies improved the staff's knowledge of giving care to alcohol dependent patients. By following ＂Clinical Practice Guidelines for Alcohol Dependence Patients＂, it is suggested that this guideline can increase the consultant rate and return rate to the psychiatry department, and it also improved the ward safety and quality of health care.

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