居家腦中風失能個案泌尿道再感染控制計畫的執行與評價

Project Implementation and Evaluation of Recurrent Urinary Tract Infection Control among Disabled Stroke Patients at Home

陳乃菁(Nai-Ching Chen) ； 高金盆(Chin-Pen Kao) ； 楊詠梅(Yung-Mei Yang)

《健康管理學刊》 13卷2期 (2015/12) Pp. 20-38

摘要

1.背景：居家腦中風失能個案再住院比例高，特別是因留置導尿管導致泌尿道感染其盛行率為51.7%，居家護理個案常因敗血性休克而入住加護病房，而感染源常見為泌尿道感染，泌尿道感染佔醫療照護相關感染比例為40%。國內仰賴外籍看護工進行居家照護，居家外籍看護工對於臥床個案之尿管照護知能普遍偏低，管路及皮膚照顧技能執行正確率僅為74%，故藉由衛生教育建立正確的尿管照護行為，以降低泌尿道感染的發生為刻不容緩的事。2.目的：針對居家腦中風失能個案之主要照顧者進行護理指導的介入計畫與執行，以降低泌尿道感染的發生並評價其計畫的成效。3.方法：以單組前、後測實驗設計，於2013 年9 月17 日至2013 年12 月31 日，收案對象為南部某醫學中心之居家照護之具有留置導尿管之腦中風失能個案的主要照顧者，共18 人，以專門設計的護理指導為介入計畫，運用Donabedian 所提出的架構，做為評價成效之指引。4.結果：居家腦中風失能個案，女性多於男性，平均年齡為79 歲，教育程度以識字為最多（55.6%），失能狀況以巴氏量表完全依賴他人為主。此計畫的介入是在醫護團隊的共同合作之下，以及運用翻譯後的衛教本，提昇與外籍照護員的溝通，進而可達有效率的衛生指導，降低文化適應的衝突，增進主要照護者完整持續的照護知識、技術指導及回覆示教，進而有效降低泌尿道感染再發生比率，由每月的33.3%降為5.6%。5.結論/實務應用：本計畫執行及評價過程中能提供有效性的因應以改善計畫成效。期望藉此經驗，提供醫護人員在執行計畫評價時之參考。

關鍵字

居家腦中風失能個案 ； 降低泌尿道再感染 ； 評價

並列摘要

Background: Home nursing care targets on middle-aged and elder stroke patients, who are more prone to re-hospitalization due to urinary tract infection (UTI) from indwelling urinary catheters, have a higher prevalence of up to 51.7%, home care cases often due to septic shock admitted to the intensive care unit, and a common source of infection is the urinary tract infection, urinary tract infections account for health care-associated infection ratio of 40%. In taiwan relies on foreign care workers carry out home care, the home care workers for foreign cases of catheter ambulatory care knowledge and ability is generally low, in piping and skills to perform the correct skin care rate was 74 percent, so health education by establishing proper catheter care behavior to reduce the incidence of urinary tract infections urgent matter. Purpose: Intervention plan and execute against the home incapacitating stroke cases of primary caregivers for care guidance to reduce the incidence of UTI and to evaluate the effectiveness of its program. Methods: With Donabedian’s structure as the guidance for evaluating effectiveness, the current study used a pre- and post-test to examine the project implementation and evaluation. The participants were main caretakers (family, foreign caretakers) of disabled stroke patients with UTI in a medical center in southern Taiwan and their home care nurses. Data ranging between 2013/9/17 - 2013/12/31 were collected. Results: The stroke disability cases that more women than men, and with an average age of 79 years, the literacy level of education to a maximum of (55.6%), in Barthel Index show the disability status is totally dependent on others based. The results revealed that the intervention of the project that through the urinary tract infection cases in high-risk group key management, and then under the co-operation of the health care team, and so on use the post-translational health textbook to enhance communication with foreign care staff, and then up to an efficient health guidance, that reduce conflict and cultural adaptation, and to enhance the main caregivers with complete and continuous caring knowledge, technological guidance, response and demonstration, thus effectively reducing the recurrence of urinary tract infection ratio from 33.3 percent down to 5.6 percent per month. Conclusions/implications: The implementation and evaluation of the project provided effective responses to improve relevant effectiveness. It is hoped that such experience provides references for medical professionals while evaluating projects.

並列關鍵字

disabled stroke patients at home ； recurrent urinary tract infection ； evaluation