提升重症護理師於連續性腎臟替代治療之警報處理執行正確率

背景：連續性腎臟替代治療是重症病人常見醫療處置，其中警報處理具緊急及時效性，若重症護理師處理不當，則會危及病人安全與存活率，但臨床無法提供護理師練習機會而出現培訓困難。2018年5月調查本單位護理師於連續性腎臟替代治療之警報處理執行正確率僅53.1%，調查原因為缺乏標準流程及參考工具、缺乏實際操作練習機會、缺乏辦理不同程度在職課程、業界無法即時協助、不熟悉各警報原因及處理等，故引發專案小組改善動機。目的：提升重症護理師於連續性腎臟替代治療之警報處理執行正確率90%以上。解決方案：本專案自2018年9月8日至2019年8月31日間，經原因分析後擬定多元教學策略，如：建立標準流程與技術考、規劃翻轉教學之案例情境模擬課程實機操作、提供情境模擬影片、設計線上情境模擬互動教學、照護手冊及簡易操作隨機卡等。結果：重症護理師於連續性腎臟替代治療之警報處理執行正確率由53.1%提升至98.9%。結論：依照學習者需求，建立標準流程及規劃多元教學策略，實體翻轉教學實作課程及線上情境模擬教學，可有效提升重症護理師進階照護認知及操作能力，提供病人安全及提高照護品質照護，並平行推展至其他重症單位。

關鍵字

連續性腎臟替代治療；線上情境模擬互動教學；重症護理；翻轉教學；警報處理

並列摘要

Background & Problems: Continuous renal replacement therapy (CRRT) is a common medical treatment for critically ill patients. The alarm management component of CRRT is urgent and time sensitive. Patient safety and survival rates are jeopardized if critical care nurses do not handle this situation properly. However, clinical settings cannot provide nurses with the opportunity to practice alarm management, which results in related training difficulties. Based on a survey conducted in May 2018, the rate of proper alarm management for the nurses in our CRRT unit was only 53.1%. An investigation attributed this low rate to inadequacies in standard procedures, resources for reference, opportunities for hands-on experience, professional training at different levels, immediate assistance from industry, and lack of familiarity with the purpose and handling of alarm incidents. These findings motivated our project team to improve alarm management. Purpose: To increase the accuracy of alarm management in CRRT critical care nurses to more than 90%. Resolutions: This project, which was implemented from September 8th, 2018 to August 31st, 2019, adopted a diverse and effective teaching strategy that included establishing standard procedures and technical tests; creating a plan for a case scenario simulation course using flipped teaching; providing scenario simulation videos; and designing online scenario simulation interactive exercises, nursing manuals, and flashcards of simplified procedures. Result: The accuracy rate of proper alarm management for CCRT critical care nurses increased from 53.1% to 98.9%. Conclusion: Diverse teaching strategies may be used to effectively enhance the care provided by critical care nurses, increase patient safety, and improve the quality of care. The findings and strategies in this study may also be applied to other intensive care units.

並列關鍵字

continuous renal replacement therapy ； online interactive simulation exercise ； critical and intensive care nursing ； flipped teaching ； alarm management

參考文獻

王家良、楊得政、王守玠、張淑鈺、鄭凌寶（2020）．連續性腎臟取代療法的介紹．腎臟與透析，32（1），31–34。[Wang, C.-L., Yang, T.-C., Wang, S.-C., Chang, S.-Y., & Cheng, L.-P. (2020). The introduction of continuous renal replacement therapy. Kidney and Dialysis, 32(1), 31–34.] https://doi.org/10.6340/KD.202003_32(1).0007

康以諾、林哲瑋、陳建宇、曾德銘、吳建志（2016）．翻轉教學應用於擬真臨床技能學習之滿意度初探．台灣擬真醫學教育期刊，3（1），23–31。[Kang, Y.-N., Lin, C.-W., Chen, J. C.-Y., Tseng, T.-M., & Wu, C.-C. (2016). An exploratory study on simulated clinical skill learning satisfaction in the flipped approach. Journal of Taiwan Simulation Society in Healthcare, 3(1), 23–31.] https://doi.org/10.6582/JTSSH.2016.3(1).03

陳秀芳、賀倫惠、李香君、邱小鳳、陳海焦、蔡青青（2020）．護理情境模擬教案設計－以重症護理課程為例．長庚護理，31（3），338–353。[Chen, H.-F., Ho, L.-H., Lee, H.-C., Chiu, H.-F., Chen, H.-C., & Tsai, C.-C. (2020). A scenario-based simulation design for critical care nursing education. Chang Gung Nursing, 31(3), 338–353.] https://doi.org/10.6386/CGN.202009_31(3).0004

Digvijay, K., Neri, M., Fan, W., Ricci, Z., & Ronco, C. (2019). International survey on the management of acute kidney injury and continuous renal replacement therapies: Year 2018. Blood Purification, 47(1-3), 113–119. https://doi.org/10.1159/000493724

Przybyl, H., Evans, J., Haley, L., Bisek, J., & Beck, E. (2017). Training and maintaining: Developing a successful and dynamic continuous renal replacement therapy program. AACN Advanced Critical Care, 28(1), 41–50. https://doi.org/10.4037/aacnacc2017122

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提升重症護理師於連續性腎臟替代治療之警報處理執行正確率

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