- 期刊
專科護理師獨立執行台灣版高齡住院病人跌倒風險因子評估表可行性研究
Independent Execution by Nurse Practitioners of Fall Risk Assessment for Hospitalized Older People Using FRHOP-Taiwan Version: A Feasibility Study
摘要
目的：醫院中發生跌倒事件以65歲以上之老年人最多，對住院病人產生許多傷害，而有三分之二的跌倒是可以預防的，但需要以多面向方式對於急性住院老年人進行跌倒風險評估與介入。本研究的目的在探討由經過訓練的專科護理師來進行多面向跌倒風險評估，其信度是否與多職類團隊共同評估相同。方法：台灣版高齡住院病人跌倒風險因子評估表（Tw-FRHOP）是由多職類醫療人員分別對新入院的病患進行多面向跌倒風險因子的評估。本研究是由一位經訓練過的專科護理師與其他職類專業人員同時進行評估，並計算專科護理師與醫師、職能治療師和物理治療師評量Tw-FRHOP量表的一致性與相關性。統計方式為計算評分者答題一致性（%）、kappa值以及總分的Pearson相關係數。結果：專科護理師與醫師施測結果有極佳一致性（一致性範圍90.3-100.0%、κ=0.773-1.000），與物理治療師亦有高度的一致性（一致性範圍83.9%-87.1%、κ=0.743-0.762），而與職能治療師整體而言仍有中等至良好的一致性（一致性範圍77.4-100% 、κ=0.429-1.000），但在衣服合身問題的kappa值較低（κ=0.271）。專科護理師與各職類人員的評分有中度到高度的相關（r=0.477-0.981）。結論：由一個經過訓練的專科護理師來進行Tw-FRHOP跌倒風險評估，與多職類團隊共同評估具良好的一致性，唯在衣服合身問題與職能治療師一致性較低。未來可考慮由經過訓練之專科護理師廣泛對新入院的病患進行Tw-FRHOP跌倒風險評估，進一步提供針對性預防和介入措施，以降低住院老年人跌倒發生率及傷害程度。
並列摘要
Objectives: Falls are a major cause of morbidity and mortality among hospitalized older adults, yet two thirds of the cases are preventable with a multifactorial fall risk assessment and subsequent interventions. The purpose of the study was to examine whether such an assessment performed by a well-trained nurse practitioner is able to emulate the one conducted by a multidisciplinary team in terms of reliability. Methods: The study used the Taiwan version of FRHOP (Fall Risk for Hospitalized Older People), a comprehensive fall risk assessment instrument for newly hospitalized patients. The regular practice is to have a multidisciplinary team perform the assessment. In this study, the FRHOP-Taiwan Version assessment was performed by a well-trained nurse practitioner, and concurrently by a physician, a physical therapist, and an occupational therapies. We analyzed and compared the consistency of the scores (% and kappa value) and the correlation of total points (Pearson correlation coefficient) of the assessments performed respectively by the nurse practitioner, the physician, and the therapists. Results: The result of the assessment performed by the nurse practitioner appeared to be highly consistent with the one performed by the physician (n=90.3%-100.0%、κ=0.773-1.000), and the consistency with the one conducted by the physical therapist and the occupational therapist were respectively moderate to good (n=83.9%-87.1%、κ=0.743-0.762) and fair to good (n=77.4%-100%、κ=0.429-1.000). However, in the item concerning the patient, the consistency was not very remarkable (κ=0.271). (κ=0.271). There was a moderate to high correlation of total point of the score between the nurse practitioner and the other medical professionals, disciplines (r=0.477-0.981). Conclusion: The FRHOP-Taiwan Version assessment performed by a well-trained nurse practitioner shows good consistency to those performed by other medical professionals except in the clothing question. Performance of the assessment by well-trained nurse practitioner can be considered to help reduce preventable fall injuries and morbidities among hospitalized elderly patients.