提升兒童加護病房新進護理師ECMO之照護能力

Enhancing the Ability of Performing ECMO Care by the Novice Nurses at the Pediatric ICU

林雅涵(Ya-Han Lin) ； 錢佳慧(Chia-Hui Chien) ； 范圭玲(Guei-Ling Fann) ； 吳美華(Mei-Hua Wu)

《台灣醫學》 26卷1期 (2022/01) Pp. 115-127

https://doi.org/10.6320/FJM.202201_26(1).0015

摘要

重症兒童使用體外維生系統（ECMO）屬於臨床危急狀況，當新進護理師執行ECMO照護能力不足時，將影響團隊運作及病人安全。藉由事件的分析及品質改善，發現新進護理師執行ECMO照護完成率僅61.3％，原因包括：缺乏臨床經驗及實作訓練、照護認知不足、對各項警訊處理流程不熟悉、相關設備種類多且流程複雜、缺乏相關學習工具、無系統性的教育訓練及未落實相關技術稽核。此次品質改善活動期望提升新進護理師執行ECMO之照護能力，改善策略包含：規劃教育訓練課程、製作影片結合翻轉教室教學、設置說明圖卡與照護手冊、舉辦情境模擬演練及建立照護能力稽核制度。經上述改善策略後，新進護理師執行ECMO照護完成率由61.3％提升至98.2％，將有助提升病人安全及重症照護品質。

關鍵字

體外維生系統（ECMO）照護 ； 翻轉教室 ； 情境模擬演練

並列摘要

The use of extra-corporeal membrane oxygenation (ECMO) is for children in critical condition. When the novice nurses have insufficient capacity to perform ECMO care, it will affect team operation and patient safety. According to events analysis and quality improvement process, we found that the completion rate of performing ECMO care by novice nurses is only 61.3%. The reasons include: lack of clinical experience and practical training, insufficient nursing knowledge, unfamiliarity with troubleshooting, various equipment, complex procedures, and lack of related learning tools, no systematic education and training, as well as not implementing evaluation protocol. In this quality improvement activity, our goal is to increase the ability of novice nurses in performing ECMO care. The quality improvement strategies include: planning education and training courses, making videos combined with flipped classrooms, setting the illustration card and nursing manual, organizing scenario-based simulation exercises, and establishing a system to evaluate nurses' care ability. After the improvement strategies, the completion rate of performing ECMO care by novice nurses increased from 61.3% to 98.2%.

並列關鍵字

ECMO care ； flipped classroom ； scenario-based simulation exercises

參考文獻

吳金玲、林怡秀、黃小萍等：兒科加護病房病人放置葉克膜護理流程完整性之改善方案。護理雜誌 2012;59:65-72。

林麗君、林惠雯、竺美蓮等：急重症護理人員執行病人安全工作壓力與因應行為之探討。弘光學報 2016;78:65-78。

楊志偉、周致丞、蕭政廷：從「醫療勝任能力」到「勝任醫療任務」：可信賴專業活動(EPAs)之實務應用。台灣醫學 2018;22:46-54。

許鈺萩、王秀禾、劉詩吟等：線上學習結合情境模擬急救教學課程於新進護理人員急救課程之成效探討。台灣擬真醫學教育期刊 2018;5:4-14。

Kiersbilck CV, Gordon E, Morris D.Ten things that nurses should know about ECMO. Intensive Care Med2016;42:753-5.