下肢靜脈潰瘍病人臨床照護指引之建立與評值

Development of Clinical Practice Guideline on Leg Pressure Ulcers

吳嘉玲(Jia-Ling Wu) ； 陳怡君(I-Chun Chen) ； 高淑雰(Shu-Fen Kao)

《馬偕護理雜誌》 12卷1期 (2018/01) Pp. 7-23

https://doi.org/10.29415/JMKN.201801_12(1).0001

摘要

足部潰瘍是台灣地區糖尿病患者常見的慢性併發症之一，25%的糖尿病患者會因足部問題而就醫，這類病人常因為疾病傷口影響生理、心理及精神與社交活動等層面。本照護指引藉JBI實證模式分三階段進行：第一階段進行系統性文獻回顧法，搜尋2009-2014年文獻及嚴謹評析，收錄系統性文獻7篇，臨床照護指引2篇，RCT 1篇，合計10篇，建立臨床指引草案；第二階段舉辦專家焦點團體，邀請12位具下肢潰瘍照護經驗專家，進行指引草案之效度檢定；第三階段採問卷調查法，調查醫院59位臨床護理人員及12位專家對照護指引實施可行性之看法。結果確認本指引共71項，含包括定義（1項）、評估（22項）、治療（30項）、預防潰瘍復發（5項）、提供照護（3項）及預防方式（10項）。本文期望藉指引建立，提供下肢靜脈潰瘍之住院病人照護，並期望藉由教育訓練與護理指導活動倡導醫療人員、病人與家屬共同重視下肢靜脈潰瘍照護，提升病人之照護品質。

關鍵字

糖尿病 ； 靜脈潰瘍 ； 下肢潰瘍 ； 臨床照護指引

並列摘要

Leg pressure ulcers are one of the most common chronic complications in diabetic patients in Taiwan. Twenty-five percent of diabetic patients are accordingly hospitalized for injuries, wounds, or infection programs on their legs or feet. Consequences of pressure ulcers are multi-faced, including physiological, psychological, mental and social activities changes. Based on the The Joanna Briggs Institute (JBI) systematic review and implementation framework, a three-phase design was used during 2009-2014 to develop the clinical guideline. In Phase I, a comprehensive systematic review was conducted to include a total of ten appraisals: seven systematic reviews, one randomized control trial, and two clinical guidelines. In phase II, a focus group was conducted to appreciate 12 clinical experts' experiences in caring for the leg pressure ulcers patients. In phase III, a feasibility survey was conducted to for the clinical guideline. Collected were opinions from 59 clinical staff nurses and 12 hospital clinicians, and the final 71-items clinical guideline was composed by one definition item, 22 assessment items, 30 treatment items, five prevention of ulcer recurrence items, 3 provision of care items, and 10 prevention mode items. This article is expected to guide the establishment of the provision of lower extremity venous ulcer inpatient care in the hopes to train and guide nursing activities and promote quality of care.

並列關鍵字

diabetes mellitus ； leg pressure ulcer ； evidence-based clinical guideline