護理之家住民口腔照護指引的建立與成效評值

Establishing and Evaluating the Effectiveness of a Set of Oral Care Guidelines for Nursing Home Residents

胡月娟(Yueh‐Juen Hwu) ； 江蕙娟(Hui‐Chaun Chiang) ； 林豐裕(Feng‐Yu Lin)

《護理暨健康照護研究》 10卷2期 (2014/06) Pp. 143-153

https://doi.org/10.6225/JNHR.10.2.143

摘要

背景：口腔護理乃為維持護理之家住民健康與舒適之要素，然而護理人員執行口腔護理卻欠缺實證指引可供依循。目的：轉譯最佳證據以改善住民口腔照護措施，並評值此口腔照護指引的成效。方法：參酌臨床實務改善過程（clinical practice improvement process），界定問題後，成立改善小組。接著採取三大階段。第一階段，採系統性回顧，萃取口腔照護的最佳實證，擬訂實證為基礎的口腔照護指引。第二階段擬訂三面向照護策略，首先是建置住民口腔照護標準步驟，機構工作人員執行策略，繼而確認機構管理策略。第三階段為測試成效，在執行口腔照護指引後，比較住民前後測牙菌斑指數與口腔健康得分，以評值口腔照護指引改善成效。結果：20位住民完成前測與後測三、四、五個月稽核，藉由重複量測變異數（repeated-measures analysis of covariance，RANCOVAs）與廣義估計模式（generalized estimation equations, GEE）分析，結果顯示，口腔照護指引能減少護理之家住民牙菌斑指數，與提升口腔健康得分，住民也表示增進舒適感。結論：執行口腔照護指引可以改善護理之家住民的口腔衛生狀況。

關鍵字

實證運用 ； 口腔衛生 ； 口腔照護指引

並列摘要

Background: Oral care is necessary to maintain the health and comfort of residents in nursing homes. However, nurses lack related evidence‐based oral care guidelines. Aim: The purposes of this project were to translate the best available evidence in order to improve residents' oral care practices and to evaluate the effectiveness of a set of oral care guidelines developed based on that evidence. Methods: We referenced the model of Clinical Practice Improvement Process (CPIP), identified the problem, and formed a working team. Afterward, we implemented this project in 3 stages. The first stage conducted a systematic review to identify the best available evidence on oral care guidelines. The second stage developed a care strategy in the 3 dimensions of standard oral care procedure for residents, the implementation strategy for nursing‐home personnel, and management strategy for institutions. Lastly, we implemented the set of developed oral care guidelines and then compared the pre‐and post‐implementation audits of plaque index and oral health score for residents to evaluate the effectiveness of the guidelines. Results: Twenty residents completed the pretest and the 3rd, 4th, and 5th‐month‐posttest audits. Results from repeated‐measures analysis of covariance (RANCOVAs) and generalized estimation equations (GEE) found significant improvements in participants' average plaque index and oral health scores as well as in average comfort scores. Conclusions: This study supports that implementing the developed set of oral care guidelines may effectively improve oral hygiene in nursing‐home residents.

並列關鍵字

evidence utilization ； oral hygiene ； oral care guideline

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