提升腦中風病房護理人員吞嚥訓練執行率之專案

A Project for Improving the Implementation Rate of Swallow Training to Nursing Staff in the Stroke Patients' Ward

林玉菜(Yu-Tsai Lin) ； 鍾宛臻(Wan-Chen Chung) ； 林宜蓁(Yi-Chen Lin) ； 陳玉未(Yu-Wei Chen) ； 陳芝文(Chih-Wen Chen)

《領導護理》 20卷2期 (2019/06) Pp. 97-110

https://doi.org/10.29494/LN.201906_20(2).0008

摘要

腦中風病人常見的吞嚥障礙為無法吞口水、嗆咳及吞嚥反射延遲等，進食是營養攝取必要的能力，若無法由口進食，病人將面臨挫折感、社交活動減少及社交隔離。臨床發現經語言治療師吞嚥訓練的病人鼻胃管拔除率極高，但單位護理人員未重視且缺乏吞嚥訓練之規範，導致鼻胃管拔除率低，主要問題為吞嚥功能評估知識與技巧不足、缺乏吞嚥訓練查檢表、缺乏衛教指導輔助工具、缺乏完整的吞嚥訓練標準作業流程。本專案目的在提昇腦中風病房護理人員吞嚥訓練執行率達80％，擬定解決方案為教育訓練、製訂吞嚥訓練查檢表、修訂吞嚥訓練標準作業流程、製作指導手冊與示範光碟，專案進行後護理人員吞嚥訓練執行率由7％提昇至82％，達本專案之目的，經落實吞嚥訓練以改善病人的吞嚥能力、減少鼻胃管留置時間、讓病人儘早回歸由口進食的能力，進而提升腦中風病人生活品質。

關鍵字

腦中風 ； 吞嚥困難 ； 吞嚥訓練

並列摘要

Dysphagia is a common symptom among stroke patients. If a stroke patient has dysphagia, he may experience pain when he swallows, possibly choking or coughing, and chances of delayed swallowing reflex. Swallow is an essential ability of nutrient intake. Without the ability to swallow, patients face a sense of frustration, their social activities reduces, and they become socially isolated. It was found that patients' nasogastric tube extraction rate is higher when the swallow training is provided by a speech and language therapist than a nursing staff. This is predominantly due to nurses' insufficient knowledge and skills in swallow training, undersupplied swallow training checklist, inadequacy health education, shortfall auxiliary tools, and absence of auditing mechanisms. This project aimed to intensify the nurse's implementation rate of swallow training for stroke patients to 80%. The proposed improving methods included educational training for staffs, constructing swallow training checklist, establishing swallow training standard procedures, and publishing swallow training guideline and demonstration DVD. After the implementation of the project, the nurses' implementation rate of swallow training for stroke patients increased from 7% to 82%, which accomplished the project's intention. The patients' swallow ability was progressed by improving the implementation rate of swallow training, and nasogastric tube retention time was hence reduced. As stroke patients' ability of oral intake improves, it also enhances their quality of life.

並列關鍵字

stroke ； difficulty swallowing ； swallow training

參考文獻

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