提升腸造口病人出院自我照顧正確率改善方案

當病人罹患直腸癌等疾病時，因病情需要會施行腸造口手術，手術後病人可能會發生腸造口回縮、剝離、壞死及造口周圍皮膚潰爛等合併症。手術後不當的照護不僅提高了合併症的發生，更增加病人造口自我照顧的困難度及社會成本。依據查檢結果，腸造口自我照顧認知平均正確率僅為42.4%，照顧技能平均正確率為78.3%。問題確立為缺乏教導標準作業流程及審查機制、衛教單張內容不完整、無適合輔助工具及技能練習次數不夠。設定目的為提升腸造口病人自我照顧平均正確率至90％。經修訂「腸造口居家自我照顧」護理指導單張、製作「結腸造口自我照顧」衛教影片、設計「腸造口模具」，並制定「腸造口病人出院自我照顧」指導標準作業流程及查檢機制，認知與技能平均正確率提升到92.7%及98.6%。以多元的方式進行修改護理指導單張、製作衛教影片及發展腸造口模具，確實增強了學習效果。專案執行後，已將「腸造口病人出院自我照顧」指導標準作業流程及查檢機制列入單位常規，護理指導單張及教學影片，也已放入院內雲端系統，並希望平行推廣至其他有需要的單位，使更多病人得到更好的照顧。

關鍵字

腸造口病人；造口合併症；出院自我照顧正確率

並列摘要

A colostomy is usually performed for patients with irreversible intestinal problems, such as rectal cancers, and improper care after the surgical procedure increases both societal, medical costs and common complications, including: intestinal retraction, resection, necrosis, and skin ulceration around the stoma. This article aims to investigate and implement a project to improve self-care accuracy for patients with colostomy prior to their discharges. Data analyzed revealed poor accuracy attributed to patients' insufficient self-care knowledge (42.4%) and skills (78.3%), a lack of standardized teaching of operative procedures, little review mechanism and assessment, and also incomplete educational materials related to auxiliary tools and skill exercises. A project was implemented and strategies were made to hopefully increase the accuracy to 90%. We developed educational training, established care regulations, updated evaluation procedures, revised the ＂colostomy home care＂ guidance, recorded an educational video, and designed a stoma model to optimize our teaching. With these changes, the average self-care accuracy rate has greatly increased that the knowledge has enhanced to 92.7% and performed skill has improved to 98.6% prior to their discharges. Moreover, the multi-dimensional, standardized educational and evaluative system has been included in the ward routine with updated ＂Guidelines for home care＂ and the ＂Educational video＂ placed in the hospital cloud system, demonstrating the utility of this project in improving the self-care quality of patients with colostomy for their discharge.

並列關鍵字

patient with colostomy ； stoma complications ； self-care accuracy

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