長期照護個案之口腔照護介入成效分析

一、前言口腔狀況不良會直接的影響到全身的健康，長期照護需求者的口腔狀況常被忽略而導致他們口腔狀況不良日益嚴重。口腔衛生不良會使細菌或牙菌斑等致病因為因子隨著口水及痰液，嗆咳而的吸入而造成吸入性肺炎。口腔照護中，針對不同的個案，其照護的方式也要有所不同。評估時，不能只看口腔狀況，應該擴大至個案的整體面，包括全身性系統疾病、用藥狀況、營養狀況甚至是個案本身的心理狀態，以及個案的各種環境因素等。二、研究目的與動機本研究目的為驗證由高雄醫學大學附設醫院特殊需求者牙科主治醫師黃純德教授所發展之口腔照護分級的臨床適切性及運用性。並瞭解不同種類系統性疾病的個案在進行口腔清潔照護上所需之策略及方式，以及瞭解照護者在口腔清潔上會遇到的問題與口腔照護介入後對個案口腔改善的成效。三、研究方法本研究為質性研究。自居家及長照機構納入9名20歲以上之長期照護需求者，針對不同種障礙類別的個案以口腔照護分級的照護方式介入口腔照護，並觀察口腔照護分級的照護方式對長期照護需求者的適切性及其成效。每位個案介入4個月以上，每2個星期為一循環，檢核個案口腔變化的狀況，及照護方法的適切性。四、研究結果結果的部分以口腔狀況記錄及訪談的模式進行撰寫。在研究中也針對各種不同系統性疾病的個案，利用口腔照護分級中所訂定之口腔照護方式運用在研究參與者身上，除了證實了各級口腔照護方式在臨床上可以成功運用外，也解決了口腔照護上會遇到的困難。五、結論因為長照個案的生理、心理及社會背景及需求各有不同，擬定口腔照護策略時，需依照個案需求，評估失能狀況、系統性疾病程度與照護者能力來設計符合個案需求的口腔照護方案，以提高照護成效。而口腔照護分類中的各級口腔照護方式，經實際應用於長期照護需求者口腔照護後，皆能符合個案需求且使口腔照護成效提升。另外則是照護者在接受個案的客制化口腔照護清潔指導後，知道如何協助個案進行口腔清潔，解決平常在清潔時會遇到的困難。

關鍵字

長期照護需求者；口腔清潔指導；口腔照護分級；質性研究

並列摘要

Back ground: Poor oral condition will directely influence our general condition. The oral condition of long-term care people is generally ignored and causes poor oral condition. A poor oral condition may cause bacteria or plaque to penetrate the lungs and cause aspiration puemonia by choking. In case management of oral care, we consider the patients condition case by case. When we evaluate their condition, we can not only evaluate their oral condition, but also their general disease, medical history, nutrition, and mental status. Purpose: The aim of this research is to identify the properties of oral care methods made from the Oral Care Degree standard (OCD) from doctor Shun-te, Huang. Also, we are curious to understand the difficulties that caregivers face when providing oral care for different types of long-term care people, and provide more effective oral care methods for them. Methods: This is a qualitative research. We recruited nine long-term care patient from Kaoshiung city. All cases were more than twenty years old and they have different disability level. Each case was indicated for the oral care methods as outlined in the OCD over four months and checked every two weeks by professional dentists. Result: We found the oral care methods of the OCD can be used well in long-term care patients. The caregivers know how to help the long-term care people after we teach them, and can solve problems when they clean the oral cavity of long-term care residents. Conclusion: When we perform a procedure for long-term care people, we should be aware of their disability level, general health and the caregivers ability, in order to raise the care effectiveness of oral care. The oral care methods from the OCD are appropriate for long-term care people. We also solved the oral care problems faced by their caregivers.