運用跨團隊照護提升肝硬化病人飲食認知之正確率

The Improvement of Diet Cognition of Patients with Liver Cirrhosis: An Implementation of Cross-Disciplinary Teamwork

廖婕彣(Chieh-Wen Liao) ； 詹依靜(I-Ching Chan) ； 郭恬妘(Tien-Yun Kuo) ； 林姿佳(Tzu-Chia Lin)

《嘉基護理》 17卷2期 (2017/12) Pp. 25-36

摘要

良好的飲食控制可以減少腹水的發生、修復肝細胞和維持體內有足夠的血漿蛋白。專案小組於現況分析發現肝硬化病人飲食認知率僅77.4%，分析原因有衛教單張內容與衛教工具不佳、護理人員對低蛋白及鹽分攝取認知不足、缺乏肝硬化飲食衛教指導標準流程與稽核、醫護團隊溝通不足。透過跨團隊合作，專案小組運用以圖片為主的衛教單張及海報、新增衛教影片、團體衛教、建立肝硬化病人飲食指導標準流程及飲食評值表、在職教育，並與醫師、營養師、社工師組成照護小組，利用團隊交班平台追蹤，使病人飲食認知率提升至94.9%，護理人員飲食認知正確率亦自91.1%提升至100%，顯現醫療團隊共同參與衛教確可有效提升病人對肝硬化飲食的認知。

關鍵字

肝硬化 ； 飲食認知 ； 跨團隊

並列摘要

A well-controlled diet could decrease the incidence of ascites, repair hepatic cell, and maintain plasma protein. However, the diet cognition among patients with liver cirrhosis was only 77.4%. Through situation analysis, four major causes were identified as follows: (i)poor-designed nursing instruction hand-outs and tool ; (ii) insufficient knowledge toward low-protein and salt intake among nurses; (iii) a lack of standard operating procedure in dietary instruction and audit; (iv) poor communication between health professionals. Though the implementation of cross-disciplinary teamwork, we designed nursing instruction hand-outs and poster mainly with pictures. We also produced a short film about diet instruction, established a standard operating procedure and assessment list for diet instruction in patients, held in-service education for nurses. We also cooperated with doctors, nutritionists and social workers, using cloud-based collaboration platform for interdisciplinary follow-up. The diet cognition among patients with liver cirrhosis increased to 77.4%, while the diet cognition among nurses raised from 91.1% to 100%. The result revealed that the diet cognition among patients with liver cirrhosis could effectively improved by cross-disciplinary cooperation.

並列關鍵字

liver cirrhosis ； diet cognition ； cross-disciplinary cooperation

參考文獻

方怡今、陳郁琪、朱冠蓁（2017）．提升慢性腎衰竭患者及主要照顧者對飲食指導的認知率．榮總護理，34(1)，40-48。doi〆10.6142/VGHN.34.1.40

楊惠卿、林淑媛（2013）．應用實證於肝性腦病變患者蛋白質飲食攝取的臨床決策．護理雜誌，60(5)，90-96。Doi:10.6224/JN.60.5.90

Pedersen, J. S., Bendtsen, F., & Moller, S. (2015). Management of cirrhotic ascites. Ther Adv Chronic Dis, 6(3), 124-137. doi: 10.1177/2040622315580069

Williams, M. V., Davis, T., Parker, R. M., & Weiss, B. D. (2002). The role of health literacy in patient-physician communication. Fam Med, 34(5), 383-389.

王憲華（2010）．跨領域團隊照護之教育訓練．醫療品質雜誌，4(4)，83-85。