運用跨專業教學於健康促進醫院發展安全病人搬移計畫之介入成效

在醫療照顧工作上，常須徒手搬運病患或協助病患，因此容易造成醫療人員與照顧者的肌肉骨骼不適（musculoskeletal disorders, MSDs）。為了降低醫療照護人員肌肉骨骼不適的發生及預防病患因搬運或轉位而產生傷害之風險，許多國家立法規定醫療照護體系需推行「安全病人搬移計畫」(Safe patient handling, SPH)或「零抬舉照顧政策」(No Lift / No Lifting Policy, NLP)，針對病患搬運與移動訂定作業流程和規範，適時正確善用照護輔具以符合人體工學的作業方式來避免醫療照護人員因徒手抬舉搬運、移動被照護者所造成的風險。本研究由職能治療師組成研究團隊，發展安全病人搬移之跨專業教學訓練計畫，以培養護理人員正確的觀念與臨床技能。本研究在北部某健康促進醫院進行，以神經內科、神經外科、復健科、高齡病房及脊髄損傷病房之護理師為介入對象。在訓練教案編製完成後，本研究先招募20位護理師進行預試，分析評量工具之「信效度」、「難易度」與「鑑別度」。在預試課後滿意度回饋上，多數受試者認為課程內容與護理人員的工作情境相關(88.9%)、符合需求(88.2%)、可解決護理人員在臨床工作上的困難(77.8%)並有效預防職業傷害(88.9%)。依據預試結果修訂評量工具與教案內容；修訂完成後，進行正式介入。正式介入階段，共招募了39位護理師，分為實驗組（19人）與對照組（20人）。在完成訓練後，實驗組在「SPH認知程度」前後測分數變化幅度上，顯著優於對照組；在「操作表現」上，實驗組成績（21.42分）也顯著優於對照組（14.00分）。在課後回饋上，多數受試者認為課程內容與護理人員的工作情境相關（97.3%）、符合護理人員需求(97.3%)、可解決護理人員在臨床工作上的困難(89.2%)並有效預防職業傷害(75.7%)。結果顯示，本研究之訓練計畫具有顯著介入成效與高滿意度。未來仍需進一步研究與規劃，以發展更完整之安全病人搬移計畫。

關鍵字

護理人員；肌肉骨骼不適；轉移位；病人搬移；零抬舉照顧政策；跨專業教學

並列摘要

In health care working context, it is common to use of manual handling to lift or move the patients. As a result, it usually causes physical injury such as musculoskeletal disorders (MSDs), to the healthcare staff and caregiver, especially nursing personnel. In order to minimize and prevent the risks of MSDs and work- related injuries associated with patient handling, many governments legislated for promoting No Lift policy (NLP) and Safe Patient Handling program (SPH) in medical system. It’s necessary to develop standard operating procedures of patient handling in health care working area, which included ideal ergonomics education, using the assistive technology and energy saving principle. This study is establishing a occupational therapist-driven model of interprofessional education project in a health promotion hospital .This project will develop a training course of safe patient handling programs and clinical care principles. The goal of project is to enhance the manual technique and literacy of the nurses. The project consisted of nurses from rehabilitation ward, neurosurgery ward, neurological ward, spinal cord injury ward and geriatric ward. The study set a pilot study to analyze the difficulty, discrimination, validity, reliability of the “SPH assessment” . In the pilot study, 20 nurses were recruited. The result of pilot study showed a great satisfaction of the training course. In the main intervention, participants were divided into intervention group (18 nurses) and control group (20 nurses). After training course, the intervention group got a significant improvement of the” SPH assessment - cognition subtest” in comparison to the control group. In the” SPH assessment - operating subtest”, the intervention group got significantly higher score than the control group. Besides, as the pilot study, the satisfaction of the training course is great in the main intervention. The result indicated that this education project could probably enhance the skills and literacy of the nurses in order to decrease the burden of patient handling and risks of MSDs. It is necessary to set more research and programs in the future. We expect the knowledge and skills of SPH can be promoted, and therefore improving the quality of medical work and healthcare.