護理人員對鼻胃管位置確認知識、態度與行為的研究

Knowledge, Attitude, and Behavior of Taiwan Nurses toward Nasogastric Tube Placement Verification

楊鳳凰(Feng-Huang Yang) ； 林豐裕(Feng-Yu Lin) ； 胡月娟(Yueh-Juen Hwu)

《澄清醫護管理雜誌》 13卷1期 (2017/01) Pp. 55-63

摘要

目的　鼻胃管乃為護理人員常做的臨床照護程序，若未執行安全的鼻胃管位置確認方式，可能會引發嚴重的病安事件。因此探討護理人員對鼻胃管位置確認方式的知識、態度與行為就很重要。方法　採結構式問卷，對中部某區域醫院的200位護理人員做調查，有效問卷回收195份（回收率97.5％）。結果　護理人員對鼻胃管位置確認方式的知識答對率最高為「鼻胃管移位至呼吸道時，病人會出現強烈咳嗽」（89.2％），最低為「鼻胃管位置確認的黃金原則是X光」（14.4％）。護理人員對採行鼻胃管位置確認指引的態度，認同度皆在同意至非常同意間。護理人員執行鼻胃管位置確認的方式，以回抽胃液與打氣聽診為主；進一步分析屬性資料對位置確認方式的影響，只有工作單位呈顯著差異（p=0.02）。在疑似鼻胃管位置不在胃內時，仍有護理人員會開始灌食；灌食期間，病人出現合併症，只有三位護理人員（1.5％）的處理步驟正確。結論　建議醫院修正鼻胃管照護指引：在回抽胃液後，加上pH值測試，且將鼻胃管位置確認方式列為護理人員在職教育的參酌。

關鍵字

鼻胃管 ； 位置確認 ； 調查 ； 護理

並列摘要

Purposes Nasogastric tube placement is a common care procedure performed by nurses. Failure to confirm tube placement affect patient-safety. Investigation of nurses’ knowledge, attitude, and behavior toward nasogastric tube verification is highly important. Methods A structured questionnaire was developed to assess the knowledge, attitude, and behavior of 200 nurses toward nasogastric tube verification in a district hospital in Taiwan. The response rate was 97.5% (n=195). Results In the Knowledge section of the questionnaire, the item, ＂When a nasogastric tube is inadvertently positioned in the respiratory tract, patients will experience severe cough,＂ received the highest rate of correct responses (89.2%). The item, ＂The gold standard tool for nasogastric tube placement verification is radiography＂ received the lowest rate of correct responses (14.4%). The attitude of nurses toward conducting nasogastric tube placement verification ranged from agreement to strong agreement. The most common methods performed by the nurses for determining the tube location were gastric aspirate and auscultatory methods. The area of discipline was a determinant of nasogastric tube placement verification (p=0.02). Some nurses proceeded with the tube feeding even when they were unsure regarding the correct tube positioning. Only three nurses (1.5%) managed patient distress correctly during tube feeding. Conclusions Our findings suggest that pH measurements of tube aspirate should be added to the best practice protocol for nasogastric tube placement and that verification of correct nasogastric tube placement should be included as one of the topics in continuous education for nurses in Taiwan.

並列關鍵字

Nasogastric tube ； Placement verification ； Survey ； Nursing