運用Miller金字塔理論提升護理人員執行肝動脈化療栓塞術護理指導成效之專案

A Project Using Miller Pyramid Theory to Improve the Effectiveness of Nurses' Nursing Guidance on Trans-Arterial Chemoembolization (TACE)

周蜜淳(Mi-Chu Chou) ； 簡靜慧(Ching-Hui Chien) ； 呂佩珍(Pei-Chien Lu) ； 陳姿廷(Tzu-Ting Chen)

《健康科技期刊》 5卷2期 (2019/03) Pp. 12-21

https://doi.org/10.6979/TJHS.201903_5(2).0002

摘要

目的：護理指導是護理人員的獨特功能之一，藉由提供完整的護理指導，提升接受肝動脈化療栓塞術（Trans-Arterial Chemoembolization; TACE）病人對治療與照護相關事項的認知及配合度，以降低其焦慮情緒及可能合併症。本專案旨在提升護理人員執行TACE護理指導成效。方法：經調查發現肝癌病人僅能正確說出TACE護理指導內容的41.2%，分析原因得知護理人員的TACE護理指導知識正確率僅有60.8%，缺乏訓練課程、標準作業、護理指導練習經驗、評值工具及查核機制。本專案運用Miller金字塔理論舉辦在職教育訓練、製作多媒體OSCE教學光碟、舉辦OSCE考試與實作訓練及運用TACE MINI-CEX評估表評值臨床護理師之護理指導情形。結果：實施結果顯示護理人員的TACE護理指導知識正確率由60.8%提升至95.0%，指導成效由41.2%提升至93.8%，已達專案目的。結論：本專案的推行確實能提升護理人員知識、能力及實作，進而提升TACE護理指導成效及照護品質。

關鍵字

Miller金字塔理論 ； 護理人員 ； 肝動脈化療栓塞

並列摘要

Objective: Nursing guidance is one of the unique functions of nurses. Adequate nursing guidance improves the patients' acceptance and awareness of matters related to treatment and care after Trans-Arterial Chemoembolization (TACE), which can reduce their severity of anxiety and the possibility of complications. This project aimed to improve the nurses' performance of providing TACE nursing guidance. Methods: An investigation showed that patients with liver cancer can only express 41.2% of the content of TACE nursing guidance correctly. Further analysis revealed that only 60.8% of nurses' knowledge on TACE nursing guidance was correct. In addition, training courses, standard operation, experience on nursing guidance practice, evaluation tools and check mechanisms were lacking. Thus, in this project, Miller pyramid theory was used to conduct on-the-job training, prepare multimedia OSCE (objective structured clinical examination) teaching CDs, organize OSCE examinations and practical training, and use TACE Mini- Clinical Evaluation Exercise (Mini-CEX) to evaluate the nursing guidance provided by clinical nurses. Results: The results showed that the correct rate of the nurses' knowledge on TACE nursing guidance increased from 60.8% to 95.0% and the effectiveness of guidance increased from 41.2% to 93.8%. The goal of the project has been achieved. Conclusions: This project actually enhanced the knowledge, ability and practice of nurses and thereby improved the effectiveness of TACE nursing guidance and care quality.

並列關鍵字

Miller pyramid theory ； nurses ； Trans-Arterial Chemo-Embolization (TACE)

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