探討壓瘡防治多元教學策略對護理人員認知及病人壓瘡發生率之影響

Effect of a Multistrategy Pressure Ulcer Prevention Education Program on Nurse Cognition and Pressure Ulcer Incidence Rates

吳秀玲(Hsiu-Ling Wu) ； 莊秋萍(Chiu-Ping Chuang) ； 林麗華(Li-Hwa Lin) ； 鄒怡真(Yi-Chen Tsou) ； 熊道芬(Tao-Fen Hsiung) ； 桑潁潁(Yiing-Yiing Sang) ； 洪世欣(Shih-Hsin Hung) ； 黃子珍(Tzyy-Jen Huang) ； 周幸生(Shin-Shang Chou)

《榮總護理》 34卷2期 (2017/06) Pp. 118-129

https://doi.org/10.6142/VGHN.34.2.118

摘要

本研究目的係運用壓瘡防治多元教學策略進行教育訓練，探討護理人員壓瘡照護之知能及對全院病人壓瘡發生率之影響。研究於北部某醫學中心施行，以實證指引為基礎設計6 小時壓瘡防治課程，利用課室教學、即時互動回饋及情境模擬等多元教學策略進行10 場教學(2016.08.02-22)，以測驗卷測量護理人員教育前後壓瘡認知之差異。擷取該院通報壓瘡指標資料分析教育介入前(2015.09-12)、後(2016.09-12) 相同四個月份之病人壓瘡發生率。全院50.4% 臨床護理人員(924位) 參與，壓瘡認知之後測較前測平均分數提高19.0 分(p ＜ .0001)；一般病房壓瘡發生率在教育介入後顯著下降(0.124%, p = .009)，部位以薦骨為最多，二級發生率下降0.026%。加護病房壓瘡發生率在教育介入後亦顯著下降(0.152%, p =.006)，甚至低於全國醫學中心壓瘡發生率平均值(0.328%)。一般病房發生壓瘡病人平均年齡超過70 歲，且以男性及內科病人為最多，壓瘡危險因子評估表並未納入上述選項，未來可考慮加入壓瘡危險因子評估之選項及教育訓練之內容。

關鍵字

多元教學策略 ； 護理人員認知 ； 壓瘡 ； 壓瘡發生率

並列摘要

The purpose of this study was to explore the differences in nurses' cognition regarding pressure ulcer (PU) prevention and treatment, as well as the pressure ulcer incidence rates (PUIRs) in patients before and after the implementation of a multistrategy education program. A 6-hour program was developed based on evidence-based practice guidelines, combining lectures, interactive response systems, and simulation teaching strategies. A total of 10 sessions were held (2016.08.02-22) for clinical staff nurses. A questionnaire was used to measure the differences in nurses' cognition before and after the session. The data regarding patients' PUIRs (2015.09-12 and 2016.09-12) were provided by hospital PUIR reporting systems to the Taiwan clinical performance indicator (TCPI) system on a monthly basis. A total of 924 nurses attended the program. After the program, their mean cognition scores were higher (p ＜ .0001), and PUIRs and stage 2 PU rates were significantly lower in general wards. In critical care units, the PUIR was improved (0.152%, p = .009), and even lower than the average data in the TCPI system (0.328%). The study results confirm the importance of multistrategy education programs in reducing PUIRs. PU was significantly more common among male patients, aged over 70 years and in patients staying in medical units. A greater emphasis should be placed on risk factors that are not listed on assessment tools.

並列關鍵字

multistrategy education program ； nurse cognition ； pressure ulcers ； pressure ulcer incidence rate

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