運用黃疸辨識卡提升主要照顧者對新生兒黃疸膚色辨識之知能

Knowledge Promotion and Identification of Skin Color Change in Neonatal Jaundice for Primary Caregiver by Using Skin Color Chart

莊舜雯(Shun-Wen Chuang) ； 羅佩佳(Pei-Jia Luo) ； 黃照伶(Chao-Ling Huang) ； 李延慧(Yen-Hua Li) ； 彭雪芳(Hsueh-Fang Peng) ； 沈青青(Ching-Ching Sheng)

《榮總護理》 32卷4期 (2015/12) Pp. 343-350

https://doi.org/10.6142/VGHN.32.4.343

摘要

據統計，60%新生兒會出現生理性黃疸，當膽紅素值超過18mg/dl，則視為「高膽紅素血症」，若未及時治療，高膽紅素血症有2%的機率進展成「核黃疸」，其死亡率達6.4%，即便存活下來，也會造成永久性的神經功能障礙。新生兒出院時護理師會教導父母黃疸觀察技巧，但因黃疸再度入院的新生兒當中有35%被確診為「高膽紅素血症」，主要照顧者常困惑不知新生兒黃疸已經這麼嚴重，表示返家後沒辦法辨識新生兒黃疸膚色。經實地觀察、訪談及「新生兒黃疸辨識知能問卷」調查，分析原因包括：一、返家後因無儀器監測，主要照顧者僅能以肉眼辨識膚色；二、新生兒黃疸照護常規中，主要照顧者出院當天才學習觀察新生兒膚色，成效不佳。故成立專案小組，製作「黃疸辨識卡」及修訂「新生兒黃疸辨識常規」改善措施，以達到提升主要照顧者對新生兒黃疸膚色辨識知能之目的。實施後主要照顧者對黃疸膚色辨識能力自我評值由2.93分提升為4.12分；主要照顧者因可早期發現新生兒黃疸，新生兒病房的高膽紅素血症發生率由35%下降至6.12%。專案效果顯著，非常適合居家照護使用，期能全面推廣到國內新生兒共同使用。

關鍵字

新生兒黃疸 ； 高膽紅素血症 ； 核黃疸 ； 黃疸辨識卡

並列摘要

Approximately 60% of newborns develop physiologic jaundice within several days of birth. Clinical data reveal that the inability of primary caregivers to distinguish the skin color change resulting from neonatal jaundice after the newborn reaches home and failure to deliver timely medical treatment can result in hyperbilirubinemia in newborns, 2% of which causes kernicterus and leads to permanent nerve dysfunction, a serious health threat; moreover, hyperbilirubinemia increases mortality by 6.4%. Therefore, a special task force was established to conduct a literature review and perform causal factor analysis, which confirmed that the problem is either that the primary caregivers do not have objective assistive treatment for distinguishing jaundice and determining the appropriate time for a hospital visit or poor instruction regarding the identifi cation of jaundice on the day of discharge. The corresponding strategies were to design a skin color chart and revise the neonatal jaundice care common practice to enhance the accuracy in identifying the skin color change in neonatal jaundice for the primary caregiver. Self-rated scores of primary caregivers in jaundice color identifi cation have increased from 2.93 points to 4.12 points, and the incidence rate of hyperbilirubinemia has decreased to 6.12% from 35% since commencement of the plan. A signifi cant effect was observed for the skin color chart, which is ideal for home care use for primary caregivers; therefore, we expect the fi ndings to be widely used for all domestic newborns.

並列關鍵字

neonatal jaundice ； hyperbilirubinemia ； kernicterus ； skin color chart

參考文獻

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