加護病房護理人員鼻胃管灌食照護完整性之改善專案

Improving the Comprehensiveness of Nursing Care for Nasogastric Tube Feeding of Patients in an Intensive Care Unit

吳虹諗(Hung-Shen Wu) ； 張巧惠(Chiao-Hui Chang) ； 陳麗貞(Li-Chen Chen) ； 林梅香(Mei-Hsiang Lin) ； 謝春蘭(Chun-Lan Hsieh)

《長庚護理》 26卷1期 (2015/03) Pp. 53-65

https://doi.org/10.3966/102673012015032601006

摘要

背景：營養狀況是決定病人的耐病力，而重症病人因疾病導致營養供應方式 無法由口進食，大多需由鼻胃管灌食提供足夠的營養支持。臨床發現單位接受鼻胃管灌食病人入住時並無腸胃不適，經3－4天後病人出現腸胃併發症，引發專案改善動機，以提升加護病房護理人員鼻胃管灌食照護完整性。目的：提升加護病房護理人員鼻胃管灌食照護完整性。方法：經現況調查發現護理人員鼻胃管灌食技術及認知之照護完整性僅達78.8%。故舉辦各種粉狀飲食沖泡說明會並建立沖泡流程、增設水溫計、研發調控流速灌食袋、訂定鼻胃管灌食提醒小口訣、修訂工具清潔標準為本專案之解決方案。結果：經專案改善後，接受鼻胃管灌食病人腸胃併發症降低，護理人員提供鼻胃管灌食照護完整性達99.2%。結論：本改善專案透過提昇鼻胃管灌食照護完整性，除降低接受鼻胃管灌食病人腸胃併發症發生，亦提升其腸道營養支持，並可提供日後臨床護理照護之參考，以提高照護品質。

關鍵字

加護病房 ； 鼻胃管灌食 ； 完整性

並列摘要

Background: The intestinal function is an important determinant in the outcome of patients admitted to the intensive care unit (ICU). Enteral feeding is the primary method of nutrition administration for ICU patients. There are no complications of nasogastric (NG) feeding at the first or second day. However, after that, most of critical patients reveal gastrointestinal discomforts. This motivates us to design a project to decrease NG feeding-related gastrointestinal distress. Purpose: Improve the comprehensiveness of nursing care for applying NG feeding in the ICU. Method: This study revealed that less than 78.8% of the ICU nurses understood nasogastric feeding technic correctly and were able to achieve comprehensive nursing care. The ICU applied three strategies to improve clinic nursing care and promote morning orientations to nurses. The standard of nasogastric feeding was established, including improving knowledge of preparation of a variety of feeding food, improving feeding tools hygiene, and adjusting feeding food temperature. Other strategies included inventing new feeding bags that can regulate NG feeding flow rate and designing the reminders of NG feeding tips. Result: After implementing the protocol, the incidence of NG feeding associated gastrointestinal complications decreased and the completeness of nursing care in NG feeding up increased to 99.2%. Conclusions: This study provided evidence to support the improvement of comprehensive NG feeding care for ICU critical inpatients with a lower gastrointestinal distress and sufficient nutritional rehabilitation. This protocol can be a model for the ICU nurses to improve the quality of care and reduce patient's length of stay in the ICU.

並列關鍵字

ICU ； nasogastric tube feeding ； comprehensive

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