以實證為基礎發展失能者失禁性皮膚炎之組合式照護

To Develop the Bundle Care of the Incontinence Associated Dermatitis in Disabled Patients: A Evidence- Based Framework

魏秀慧

失能者 ； 失禁性皮膚炎 ； 組合式照護 ； Disabled patients ； incontinence associated dermatitis ； bundle care

長榮大學護理學系(所)學位論文

2016年

碩士

黃芷苓

繁體中文

背景：失禁性皮膚炎為臨床上常見的皮膚損傷問題，會造成病人皮膚的燒灼、癢、疼痛不適及感染，延長住院天數和增加照護負擔。 目的：本研究目的為以實證護理為架構，發展失能者失禁性皮膚炎之組合式照護。 方法：本研究乃依據組合式照護發展原則，共9個步驟，於南部某醫學中心進行，透過系統性文獻回顧方式分析資料，擬定組合式照護草案，以及進行護理人員與臨床專家共識決策程序，並且方法學專家審查品質，最後完成失禁性皮膚炎組合式照護。 結果：本研究結果所發展之「失禁性皮膚炎之組合式照護」，乃經30位護理人員進行問卷調查，7位臨床專家進行兩回合問卷調查，達80%以上同意，3位方法學專家審核品質為建議使用。組合式照護指引內容有四大面向，包含皮膚評估、皮膚清潔、皮膚保護與支持性介入措施，總共19項照護措施，此組合式照護透過完整系統性文獻回顧，依實證照護架構所發展出來，可以提供臨床護理人員有實證基礎之標準化照護準則，以改善失能者失禁性皮膚炎情況。 結論：本研究結果所發展之失禁性皮膚炎的組合式照護，整合文獻證據，具臨床護理人員和臨床專家共識決策，方法學專家品質審核的嚴謹度，未來將於臨床進行照護指引測試。

Background: Incontinence-associated dermatitis (IAD) is a prevalent cause of skin damage in clinical settings. IAD may cause burn heat sensation, pru- ritus, pain, and infection .It may prolong hospital stay and increase healthcare costs. Objective: The aim of this study was to develop a bundle care of the incontinence associated dermatitis based on the evidence- based framework in the disabled patients. Method: According to the steps of developing a bundle care, 9 steps were conducted. A multidisciplinary task group was established at a medical center in southern Taiwan. The steps included systematic review of the literature, a draft of IAD budle care, consensus of hospital nursing staff and clinical experts, evaluation of methodology experts. Results: The initial guideline was consensused by thirty nurses and seven clinical experts (two runs) to achieve above 80% agreement. Three methodology experts evaluated the quality of development process as a use recommendation. The IAD Bundle care consisted of 4 elements with 19 interventions, including skin assessment, skin cleanse, skin protect, and supportive interventions. The IAD bundle care was standardized and evidence- based clinical guideline. Conclusion: The result was the development of IAD bundle care, which integrating systematic literature review and the opinions of nurse staff, clinical experts, and methodology experts. Thus, these Bundle care are recommended for clinical application. Further studies will be implemented to test the effectiveness of IAD bundle care.

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