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應用設計思考於護理創新服務方案:以腹腔鏡膽囊切除術後病人為例

Applying Design Thinking in Innovative Nursing Services: A Case Study of Patient Care Post Laparoscopic Cholecystectomy

Abstracts


本文為照護一位因急性膽囊炎接受腹腔鏡膽囊切除術之術後病人,筆者以病人為中心,運用設計思考進行同理、傾聽病人的需求,透過訪談紀錄、界定理解問題,確認病人鼻樑皮膚因反覆黏貼宜拉膠而疼痛、對飲食習慣改變及返家後需記錄引流液感到焦慮等三項問題,進一步構思發想出具個別化的護理措施,分別設計出改良式鼻胃管固定貼片、膽囊切除術後病人飲食紀錄日誌及簡易型JP引流液比色卡等三項創新服務方案,達到預防皮膚損傷與減少疼痛感、增進術後飲食認知、JP引流液評估與紀錄的正確性之目的。使用改良式鼻胃管固定貼片可促進鼻部皮膚舒適度、清潔便利性;膽囊切除術後病人飲食紀錄日誌具操作便利、內容實用與排版易讀性,可用於膽囊切除術後病人之低脂飲食衛教,提升病人飲食遵從性並減少腹瀉發生,及作為營養評估之參考依據;簡易型JP引流液比色卡可作為護理師紀錄輸出量與交接班之輔助工具,提升引流液顏色認知一致性,其操作簡單亦可協助病人返家後,引流液顏色評估與紀錄。未來建議可將本創新方案成效做為護理品質改善專案或衛教指導標準作業之依據。

Parallel abstracts


This study describes the nursing experience of caring for a patient who received a laparoscopic cholecystectomy following acute cholecystitis. A patient-oriented approach was adopted in combination with design thinking to treat the patient empathetically and to satisfy his needs. Interview records were examined to identify three health problems experienced by the patient, namely nose pain due to repeated use of elastic adhesive tapes, changes in eating habits, and anxiety caused by the need to keep a gallbladder drainage record at home. To address these problems, an individualized nursing scheme was formulated, in which an improved nasogastric tube tape was designed, a post-cholecystectomy diet diary was created, and a simplified JP drainage color chart was provided for the patient. The objective was to prevent skin damage and alleviate pain caused by adhesive tapes, improve the understanding of postoperative eating practices, and increase the accuracy of drainage color assessment and records. The results verified that the new nasogastric tube tape improved the patient's skin and level of comfort, in addition to being easily removed. The diet diary was simple to use, provided useful information, and had a typesetting that was easy to read. It also served as a health education tool for the patient to understand low-fat diets, improved his diet compliance, reduced the occurrence of diarrhea, and provided referential data for nutrition assessment. The simplified JP drainage color chart enabled nurses to record the drainage amount, facilitated task handover between shifts, and enhanced the consistency of drainage color comparisons. The chart was simple to use, allowing the patient to assess and record the drainage color at home after being discharged from the hospital. The nursing scheme proposed in this study can serve as a reference for subsequent nursing quality improvement projects or health education guidelines.

References


林姵妘、林淑華、林筱芳(2017).運用創意衛教模式提升血液透析病人對高磷飲食之認知.臺灣腎臟護理學會雜誌,16(2),44-59。http://dx.doi.org/10.3966/172674042 017061602004
李惠英、劉怡俊、吳怡雯、林妍君、陳香吟、林娉婷(2016). 運用食物圖片教材輔助個別化營養教育對慢性腎臟病人之飲食知識、態度、行為成效.臺灣營養學會雜誌,41(1),25-39。http://dx.doi.org/10.6691/NSJ.201603_41(1).0003
廖淑貞、張文忠、游曉蕙、蘇瑜鵑、蔡雅琪、陳尹甄(2016). 比較兩種固定方案對氣管插管相關性壓瘡之預防成效.健康與建築雜誌,3 (2),49-55。http://dx.doi.org/10.6299/jha.2016.3.2.R5.49
劉心怡、孫閫範、黃瀞萱、黃千郁、賴美玉(2017).運用衛教指導技巧提升腹膜透析病人血磷控制之成效,臺灣腎臟護理學會雜誌,16(1),42-55。http://dx.doi.org/10.3966/172674042017031601004
Altomare, D. F., & Rotelli, M. T. (2019). Nutritional Support after Cholecystectomy. In D. F. Altomare & M. T. Rotelli (Eds.), Nutritional Support after Gastrointestinal Surgery (1st ed., pp. 37-42). Springer. http://dx.doi.org/10.1007/978-3-030-16554-3

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