提升長期臥床病人被動關節運動之專案

Improve Caregiver’s Ability to Provide Passive Joint Exercise for Long-term Bedridden Patients

林于茜(Yu-Chien Lin) ； 李芬鴦(Fen-Yang Lee) ； 陳瑞芳(Jui-Fang Chen)

《源遠護理》 9卷3期 (2015/09) Pp. 46-54

https://doi.org/10.6530/YYN/2015.3.06

摘要

被動關節運動對於長期臥床病人是重要的，本單位長期臥床病人占75%，調查發現單位內長期臥床病人被動關節執行正確率只有46.3%，照顧者對於長期臥床病人被動關節運動護理指導滿意度更只有3.1分。其主要原因為︰護理人員缺乏長期臥床病人被動關節運動執行正確知識、未制定長期臥床病人被動關節運動護理指導手冊供使用，因此與復健科共同訂定長期臥床病人被動關節運動護理指導手冊並加強相關教育訓練，經方案介入實施後，提高了護理人員認知及技能，進而促使長期臥床病人被動關節運動正確率提升到90.2%，護理指導滿意度提升至4.7分，單位未再有家屬抱怨，且無病人發生關節僵硬、肌肉孿縮現象；顯示專案措施可改善病人照顧品質並證實跨團隊合作更能提升照護成效。

關鍵字

長期臥床 ； 被動關節運動 ； 護理指導 ； 照顧者 ； 專案

並列摘要

The article describes the improvement project to train staff and caregivers on passive joint exercise for long-term bedridden patients. Passive joints movement exercises can prevent joint stiffness and muscular atrophy in bed-ridden patients. 75% of the patients in the studied unit were long term bedridden patients. A unit survey revealed that the rate of accuracy in passive exercises for these bedridden patients was 46.3%. The caregivers’ satisfaction on the care and instructions received was below 3.1 points on a scale of 1 to 5 with 5 as most satisfied. The reasons were (1) insufficient nurse training on passive joints movement exercise, and (2) lack of an instructional manual for caregivers. A collaborative effort with hospital Rehabilitation Department developed a nurse education and training program and a standard instructional manual. The training program improved nursing staff’s knowledge and skills on passive joints movement for the longterm bedridden patients. The correct performance rate after training rose to 90.2%. Satisfaction with care and guidance increased to 4.7 points and no more family complaints about patients’ joints stiffness and muscle contracture. The results support that multidisciplinary collaboration contributed to the proper implementation of this project and lead to the improvement in the quality of patient care.

並列關鍵字

long term bedridden patients ； passive joint movement ； nursing instruction ； caregiver ； project

參考文獻

Green, T. L., & King, K. M. (2010). Functional and psychosocial outcomes 1 year after mild stroke.Journal of Stroke & Cerebrovascular Diseases, 19(1), 10-16. doi:10.1016/j.jstrokecerebrovasdis.2009.02.005

Hinojosa, M. S., & Rittm, M.R. (2007). Stroke caregiver information needs: Comparison of Mainland and Puerto Rican caregivers. Journal of Rehabilitation Research & Development, 44(5), 649-658. doi:10.1682/JRRD.2006.10.0131

Ivey, F. M., Hafer-Macko, C. E., & Macko, R. F. (2008). Exercise training for cardiometabolic adaptation after stroke. Journal of Cardiopulmonary Rehabilitation and Prevention, 28(1), 2-11. doi:10.1097/01.HCR.0000311501.57022.a8

吳美金、張美珍（2011）．提升腦中風病人執行被動關節運動之完整率．嘉基護理，11（2），22-34。

周立偉（2007）．強化腦中風預後及早復健是關鍵．中國醫訊，48，24-27。