壓瘡發生原因探討-以某地區醫院內科病房為例

Study on the causes of pressure sores- A case study of medical wards in a district hospital

王文珊(Wen-Shan Wang)

指導教授 ： 謝幸燕

義守大學/醫學院/醫務管理學系/碩士(2017年)

摘要

壓瘡，是目前醫療照護單位時問重視的問題，也是照護服務品質重要的指標之一。壓瘡的發生，可能會延長住院天數、疼痛甚至嚴重感染造成死亡，因此預防壓瘡非常重要。需臥床仰賴他人照顧，對病患來說是別無選擇；對照顧者來說確實是一項辛苦的工作，如何能夠讓病患舒適，不再造成更多的傷害，相對也可以避免增加照顧者的負擔。
本研究採質性研究法個案研究法，搜集病房的次級資料，以半結構式訪談方式，經過單位主管同意，實地參觀訪查該病房環境，隨機向病房10位護理師及6位照顧服務員進行訪談，瞭解該病房護理人員及照顧服務員對於病患出現壓瘡的解釋，探討壓瘡難以預防的原因。
研究結果發現，該病房壓瘡困難預防的原因，內在因素有：因病患疾病本身因素容易形成壓瘡、活動度差併長期臥床、需進行保護性約束個案數多；護理師之間缺乏溝通，認知不一致、參加相關在職教育課程不足且意願低落、單位管理者管理方式等；照顧服務員與護理師間溝通不良、年齡與教育程度落差較大，認知、相關課程在職教育缺乏，認知偏差。外在因素有：缺乏正向的工作環境、設備不足、壓瘡監測工具不足等問題。
偏遠地區的醫療問題與許是比較不容易被看見的，本研究有別其他和壓瘡相關研究用數字來衡量，而是直接由前線工作人員以開放式的答題，傾聽他們的想法，了解原因，找出整個單位內的問題，以利單位內進行改善。甚至期望能夠讓其他類似型態的醫院環境或偏鄉地區的養護機構作為借鏡，作為經營方針。

關鍵字

壓瘡 ； 質性研究 ； 正向工作環境

並列摘要

Pressure ulcers receives considerable attention from health care workers and represent an indicator crucial to health care quality. These Once pressure ulcers occur to inpatients, they may are painful, can prolong the patients’ hospital stays and cause pain or even serious fatal infections. Thus, preventing on of pressure ulcers is crucial. If a patient is bedridden, they have no choice but to depend on others for their care; and such caring is not easy for the caregiver. Hence, approaches that can prevent patients from developing further injuries should be established to improve their comfort as well as to ease the burden of their caregivers.
This study used a qualitative research.The research was conducted using case study and semi-structured interviews were administered. With the agreement of the ward manager, the research team conducted a field visit to examine the ward environment; 10 nurses and 6 caregivers at the ward were chosen randomly and interviewed to explore their understanding of the occurrence of pressure ulcers and why they are difficult to prevent.
The research results revealed the internal and external factors making pressure ulcers difficult to prevent in the investigated ward. Regarding the patients, their diseases, low levels of mobility combined with being chronically bedridden, and the necessity of a large number of them to receive protective restraints increased their probability of developing pressure ulcers. Additionally, the lack of communication and cognitive inconsistency among nurses, inadequate in-service training courses provided to nurses and their low intention to participate in these courses, and inappropriate management approach of the ward manager added difficulty in pressure ulcer prevention. Moreover, poor communication between caregivers and nurses, relatively large gaps between caregivers’ and nurses’ ages and education levels, the lack of relevant in-service training courses provided to caregivers, and cognitive errors observed among caregivers were part of the reasons. External factors affecting pressure ulcer prevalence include the lack of a positive work environment, equipment, and pressure ulcer monitoring tools.
Medical problems in remote areas tend to be undetected. This study differed from other studies that performed quantitative analysis on pressure ulcer prevalence; the research team directly interviewed frontline workers using open-ended questions, listened to their thoughts on the issue to understand the causes and identify the problems within the wards, and enabled the wards to make necessary improvements. The results of this study can serve as a reference for similar hospital environments or remote area healthcare agencies to develop their management guidelines.

並列關鍵字

Pressure ulcer ； qualitative research ； positive work environment

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