提升全膝關節置換手術護理指導成效之專案

Enhancing the Effectiveness of Nursing Guidance for Total Knee Arthroplasties

陳晏緹(Yen-Ti Chen) ； 張瓊文(Chiung-Wen Chang) ； 蔡宛靜(Wan-Ching Tsai) ； 楊婉萍(Wan-Ping Yang)

《志為護理-慈濟護理雜誌》 21卷4期 (2022/08) Pp. 76-86

摘要

膝關節置換術高齡病人面對手術的壓力及挑戰，再加上住院天數短、認知不足等，常導致復原狀況差。現況問題：（1）.護理指導缺乏連貫一致與整合性內容；（2）.一對一護理指導費時費力且成效差；（3）.缺乏創新性護理指導策略與工具。擬定策略：跨團隊參與復原措施、多點式護理指導、團體衛教、標準化衛教工具、研製復健口訣與每日進度表等。透過滾動式修正之專案，建立有效性的標準化護理指導流程。介入後「病人復原成效」由58.3%提升至98.3%，進步率為68.6%，病人護理指導完整度高達98%。運用長者同儕增強信心、復健動能及意願，進而提升病人復健技巧及復原。

關鍵字

膝關節置換手術 ； 高齡 ； 護理指導

並列摘要

This project aimed to enhance the effectiveness of nursing guidance and patient education to improve the recovery ability of patients after total knee arthroplasties. There is a high level of stress and challenge when the elderly face surgery. The patient recovery rate after total knee arthroplasties in 2019 is 50-70%, due in part to problems in nursing guidance including : 1. lacks coherent and consistent multi-point integrated content; 2. one-by-one nursing guidance time consuming and ineffective; 3. lack of innovative strategies and tools. To address these issues we implemented the following strategies: interdisciplinary cooperation; multi-point nursing guidance; plan on-the-job education and group health education; formulation of standard health education tools; rehabilitation formula leaflets and rehabilitation daily schedule.. Group dynamics were used to enhance confidence, motivation, and willingness to improve patient rehabilitation skills and recovery. After implementation of this multi-intervention approach, the ＂patient recovery effectiveness rate＂ increased from 58.3% to 98.3%, and the progress rate was 68.6%. The target achievement rate is 123%. The completed rate of the ＂Knee Replacement Patient Nursing Guidance Sheet＂ is 98%. This project establishes effective, standardized nursing guidance for total knee arthroplasties through rolling revision.

並列關鍵字

elderly ； nursing guidance ； total knee arthroplasties

參考文獻

李保桂、謝承樸(2016)．淺談退化性膝關節炎．彰化護理，23 (3)，2-4。https://doi.org/10.6647/CN.23.03.02。

高傳真、高宗桂(2017)．膝關節骨性關節炎的功能測評法．臺灣中醫科學雜誌，9 (2)，20-30。https://doi.org/10.29810/SJTTCM.201703_9(2).0003。

張丞淯、許曉霈、梁惠玉、林冠宏、陳淑芬(2018)．學習者分析－探討年齡、性別與閱讀力對高齡髖部骨折患者術後恢復的關係．教育科學研究期刊，63(2)，25-43。https://doi.org/10.6209/JORIES.201806_63(2).0002。

辜美安、蔡坤維、林詩淳(2015)．非藥物方法緩解老年人慢性疼痛的實證醫學．臺灣老年醫學暨老年學雜誌，10(2)，63-72。https://doi.org/ 10.29461/TGG.201505_10(2).0001。

黃珊、蔣玉滿、黃惠卿、郭美玲(2020)．建置多媒體影音護理指導提升人工膝關節置換術病人自我照顧認知的正確率．長庚護理，31(4)，503–516。https://doi.org/ 10.6386/CGN.202012_31(4).0005。