提升創傷性腦損傷開顱術後病人翻身擺位之正確率

Elevating the Accuracy Rate of Postural Change in Patient with Traumatic Brain Injury after Craniotomy

江家貞(Jia-Zhen Jiang) ； 蔡函真(Han-Chen Tsai) ； 王淑珍(Shu-Chen Wang) ； 呂佩珍(Pei-Chien Lu) ； 范君瑜(Jun-Yu Fan) ； 郭素娥(Su-Er Guo)

《馬偕護理雜誌》 8卷2期 (2014/07) Pp. 26-37

https://doi.org/10.29415/JMKN.201407_8(2).0003

摘要

不正確的翻身擺位，會使創傷性腦損傷病患的顱內壓升高，造成續發性腦損傷。筆者於2010年1-4月期間調查某區域醫院外科加護病房創傷性腦損傷開顱術後病患30位，其中22位（73.33%）出現顱內壓上升，引發專案動機。分析後確認問題：護理人員翻身擺位認知不足，技能不正確，作業流程不完整。為提升護理人員翻身擺位認知及技能之正確率，擬定專案策略：舉辦在職教育，創新翻身擺位輔具，修訂翻身擺位作業規範及流程。實施專案後，翻身擺位正確率由63.64%提升為100%；認知由69.32分提升為92.50分。本專案可提升照護品質，促進病人安全，並可提供其他與翻身擺位相關之臨床照護參考。

關鍵字

創傷性腦損傷 ； 開顱術 ； 顱內高壓 ； 翻身擺位 ； 姿勢

並列摘要

Inaccuracy of postural change can increase intracranial pressure in patient with traumatic brain injury and cause their secondary brain injury. Thirty patients with traumatic brain injury after craniotomy in surgery intensive care units (SICU) at a regional hospital, from January to April 2010, were surveyed. The incidence rate of 73.33% initiated the authors' motivation to assess and develop this project. After analyzing the current procedures in SICU, the proposed improvement project included: (1) to establish in-service trainings of postural change procedures; (2) to create tools for helping nurses change patients' posture safely; (3) to amend the standard and procedure of postural change. After performing this project, the accurate rate of the nurse's skills on postural change has increased to 100% and knowledge increased to 92.5 %. This project improved nursing quality, patient safety, and also provided a useful example of nursing care in patients with craniotomy.

並列關鍵字

Traumatic Brain Injury ； Craniotomy ； Intracranial pressure ； Postural change