運用多元教學策略提升護理師自由皮瓣評估正確率

Multiple teaching strategies for nurses to improve the accuracy rate of correctly assessing free flaps

陳怡陵(Yi-Ling Chen) ； 余惠琴(Hui-Gin Yu) ； 蘇琬欣(Wan-Hsin Su) ； 郭楊卿(Yang-Ching Kuo) ； 王健興(Chien-Hsing Wang) ； 呂基燕(Ji-Yan Lyu)

《安泰醫護雜誌》 28卷1期 (2022/06) Pp. 29-41

摘要

自由皮瓣移植的血管阻塞，若能及早發現，立即通報醫師進行搶救，皮瓣存活率可達100%，故護理人員能正確評估皮瓣狀況是非常重要的。本單位為整形外科病房，2015－2016年間有八件皮瓣循環異常事件，其中有五件未及時發現，延遲搶救的黃金期，導致皮瓣壞死，故引發小組成員執行專案改善的動機。收集資料方法是針對本單位護理師進行直接觀察，發現問題為自由皮瓣評估正確率低，僅49.21%，原因：沒有規範評估方法、沒有醫囑、沒學過此評估方法。本專案目的為提升護理人員自由皮瓣評估正確率達90%以上。解決辦法是運用多元教學策略：舉辦翻轉教室、床邊教學、製作可攜式判讀圖卡及建立自由皮瓣照護標準，教導護理師皮瓣評估應包含血流、微血管回填、溫度、飽滿度及顏色。結果與結論：評值護理師自由皮瓣評估正確率由原本49.21%提升至93.85%，達專案目標。

關鍵字

自由皮瓣 ； 多元教學策略 ； 床邊教學

並列摘要

It is critical for nursing staffs to correctly assess the condition of free flaps. In case of thrombosis, early detection and treatment may achieve 100% success rate of free flap. Eight flap abnormal events occurred in the plastic surgery ward from 2015 to 2016. In 5 cases, nursing staffs failed to detect the abnormality in time and led to necrosis of the flaps. Therefore, a plan to improve the assessment of free flaps was initiated. In a preliminary study, nursing staffs were found to correctly assess the condition of the free flaps in 49.21% of the cases. This was likely a result of the lack of proper guideline of the assessment, lack of training based on the guideline, and the absence of clinical order. This project aimed at improving the correct free flap evaluation rate by nursing staffs to over 90%. A multi-disciplinary approach employing flip classrooms, bedside teaching, pocket interpretation cards, and proper guidelines to train nursing staffs to assess the condition of the flap based on Doppler, capillary refill, temperature, texture and color of the flap. RESULTS AND CONCLUSION: The correct flap assessment rate by nursing staffs was improved to 93.85%.

並列關鍵字

Free Flap ； Multiple teaching strategies