- 期刊
臺灣急性後期照護現況與護理人員的角色功能
Post-Acute Care in Taiwan and the Roles and Functions of Nurses
摘要
在高齡社會與健保給付制度挑戰下，許多高齡長者出院時難以恢復原來生活狀態，對醫療體系、家庭及社會照顧造成極大負擔。為促進高齡長者恢復身體功能，降低急性醫療負擔且預防過早入住長照機構，衛生福利部於2009年推動中期照護之實驗計畫。2014年，進一步實施腦中風急性後期整合照護（Post-Acute Care, 簡稱PAC）計畫；2017年擴大至腦中風、燒燙傷、創傷性神經損傷、脆弱性骨折、心臟衰竭、衰弱高齡病人等六種疾病，旨在於協助病人功能恢復並降低再入院風險。2020年，進一步推動針對有腦中風具復健潛能者之「一般護理之家急性後期復健照護試辦計畫」，該計畫至今成效良好。護理人員PAC計畫中扮演重要角色，不僅限於提供臨床護理，還涵蓋了全面性功能評估、傷口護理、營養介入以及社會資源整合等多面向，這為PAC成功實施和病人復原提供堅實基礎。2023年將護理之家納入PAC試辦計畫，建議護理之家能比照美國轉型為技術型護理之家，使護理人員可於PAC照護體系中擔任領導角色，以優化病人之照護。
並列摘要
Given the challenges posed by an aging society and the health insurance payment system, elderly patients often face difficulties in returning to their prior functional status, placing a strain on the medical infrastructure, families, and social care services. To address these issues, the Ministry of Health and Welfare initiated an experimental project for intermediate care in 2009, aimed at improving functional recovery among the elderly, alleviating the burden on acute medical services, and preventing early admission into long-term care facilities. By 2014, this effort evolved into the implementation of the Post-Acute Care (PAC) program targeting patient with stroke. The program was further expanded in 2017 to encompass patients with burns, traumatic nerve injury, fragile fracture, heart failure, and weakness and aging, in addition to stroke, aiming to improve functional outcomes and lower the rates of hospital readmission. In 2020, "General Nursing Home PAC Pilot Program" was introduced for patients with stroke, showcasing positive outcomes. Nurses are fundamental to the success of the PAC program, offering a spectrum of services that extend beyond clinical care to include detailed functional assessments, wound care, nutritional counseling, and the integration of social resources. Their comprehensive involvement establishes a solid groundwork for the PAC program's successful execution and the recuperation of patients. In 2023, the Ministry of Health and Welfare plans to broaden the PAC program to encompass nursing homes, urging the transformation of Taiwanese nursing homes into skill-based establishments akin to those in the United States. Within this proposed model, nurses are expected to undertake leadership roles within the PAC care framework, significantly improving the caliber of patient care.