提升腦中風病人執行吞嚥訓練自我練習完整率

吞嚥困難為腦中風病人常見合併症，若能早期評估，確認病人吞嚥困難症狀，儘早執行吞嚥訓練，並督促病人每日自我練習，將可提升吞嚥功能，縮短鼻胃管留置時間。單位病人執行吞嚥訓練自我練習率為0%，故引發動機，專案目地旨在提升腦中風病人執行吞嚥訓練自我練習率。經現況分析確認練習率低的原因為缺乏督促病人吞嚥訓練練習機制及訓練紀錄、護理人員吞嚥評估訓練專業知能不足、缺乏吞嚥訓練衛教資料。經制定吞嚥評估訓練照護流程及吞嚥訓練自我練習評核表、安排相關在職教育與評核機制、製作吞嚥訓練衛教資料等措施，將吞嚥訓練自我練習完整率提升至94.4%，鼻胃管脫離率也由25%增加至53.8%，達專案目標。建議將督促病人吞嚥訓練自我練習機制推廣至頭頸部手術、腦創傷有吞嚥困難患者，提升病人照護及生活品質。

關鍵字

吞嚥困難；吞嚥訓練；腦中風

並列摘要

Dysphagia is a common complication among stroke patients. Early assessment and confirmation of dysphagia, implementing swallowing training as soon as possible, and urging patients to engage in self-training daily to improve swallowing function shorten the nasogastric tube indwelling time. Because the swallowing self-training rate of patients was 0%, we aimed to improve the rate of swallowing self-training among stroke patients. Analysis revealed that the reasons for the low practice rate were lack of a swallowing-training self-practice mechanism and record, deficiencies in the swallowing assessment and training knowledge of nursing staff, and lack of health education information for swallowing training. Swallowing assessment training and care procedures, a daily swallowing assessment training exercise schedule, related on-the-job education and assessment mechanisms, and swallowing training materials were implemented. The swallowing self-training rate increased to 94.4%, and the rate of detachment from nasogastric tube increased from 25% to 53.8%. Therefore, self-training mechanisms for supervising a patient's swallowing training should be promoted for head and neck surgery and patients with brain trauma who have dysphagia, thus improving patient care and quality of life.

並列關鍵字

dysphagia ； swallowing training ； stroke

參考文獻

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被引用紀錄

柳雅雲、徐琬茵、鄭雪梅（2023）。運用自我管理於三高合併腦中風病人之照護經驗。高雄護理雜誌，40(2)，177-188。https://doi.org/10.6692/KJN.202308_40(2).0015

江彥萩、陳惇杰、李月麗、潘慧娟、陳筱伶、李育珮、沈桂鳳（2021）。謝克氏運動對腦中風病人在吞嚥困難之成效：系統性回顧暨統合分析。高雄護理雜誌，38(2)，19-30。https://doi.org/10.6692/KJN.202108_38(2).0002

潘淑玫、曾雪英（2022）。一位腦出血術後個案於急性後期照護之護理經驗。長庚護理，33(2)，106-117。https://doi.org/10.6386/CGN.202206_33(2).0010

李蘋芝、林靖芸（2023）。照顧一位腦中風個案合併吞嚥障礙之護理經驗。領導護理，24(2)，34-48。https://doi.org/10.29494/LN.202306_24(2).0004

延伸閱讀

莊雅文、湯雅筑、羅宇婷、林恩如、廖惠娟（2018）。提升腦中風病房護理人員執行吞嚥功能評估正確率之專案改善。嘉基護理，18(2)，32-42。https://www.airitilibrary.com/Article/Detail?DocID=1816661x-201812-201812270016-201812270016-32-42
吳思慧、趙千淑、陳香蘭（2016）。提升腦中風病人吞嚥困難評估及進食指導執行率。新臺北護理期刊，18(1)，69-81。https://doi.org/10.6540/NTJN.2016.1.006
柯麗芬、周美香、陳秀英、林妙璦（2010）。腦中風病人吞嚥訓練改善方案。榮總護理，27(1)，36-42。https://doi.org/10.6142/VGHN.27.1.36
林玉菜、鍾宛臻、林宜蓁、陳玉未、陳芝文（2019）。提升腦中風病房護理人員吞嚥訓練執行率之專案。領導護理，20(2)，97-110。https://doi.org/10.29494/LN.201906_20(2).0008
Soon, K. S., Lee, M. Y., Tsai, W. W., Lin, C. F., & Chen, C. H. (2013). Development of a Swallowing Electrical Stimulation System for Treatment of Dysphagia in Stroke Patients. Journal of Medical and Biological Engineering, 33(5), 497-503. https://www.airitilibrary.com/Article/Detail?DocID=16090985-201310-201311050002-201311050002-497-503

國際替代計量

提升腦中風病人執行吞嚥訓練自我練習完整率

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