運用參與式行動研究提升長期照護經皮內視鏡胃造口的使用

An Participatory Action Research to Enhance Percutaneous Endoscopic Gastrostomy Appropriate Use in Long Term Care

葉莉莉

胃造口 ； 參與式行動研究 ； 夥伴 ； Percutaneous endoscopic gastrostomy ； participatory action research ； partner

成功大學健康照護科學研究所學位論文

2012年

博士

陳清惠

繁體中文

國內研究顯示腸道營養支持，是長期照護服務中需求最大的照護項目。1980年經皮內視鏡胃造口(percutaneous endoscopic gastrostomy，以下簡稱胃造口)於西方國家推展，需長期腸道營養支持者，現有文獻顯示使用胃造口的成果優於鼻胃管。台灣從1994年引入此技術，惟十多年來在長期照護體系中難以推廣，本計畫應用參與式行動研究，組成胃造口推廣中心，建置各式衛教資源，含單張、手冊、海報、影片及教育訓練教材等，供人員教育訓練使用。 計畫執行的第一階段(2008.12~2009.5)為試行期，與六機構組成夥伴，在參與合作及賦權過程中，建立胃造口推動方案。第二年擴大夥伴招募，總計執行期間有62個夥伴加入。夥伴的推廣行動包括在結構面研擬計劃與推廣政策，設計流程與表單，過程面進行人員的教育訓練與照顧者的推廣活動，結果傳遞胃造口訊息給約6000人；26個夥伴機構共執行309個胃造口處置，平均胃造口個案佔長期灌食者5.78%，其中177位改用胃造口病人的胃出血、再入院與約束等問題顯著低於鼻胃管放置時。統計分析顯示夥伴為醫院類型、有研擬推廣政策、發展相關流程及定期做胃造口適切評估者，其胃造口個案較多（p < .05）；加入前有胃造口個案、有合作醫院、尋求中心協助、有辦教育訓練及使用適切性評估單的夥伴成果也較佳（p < .01）。 另由問卷及焦點訪談顯示衛教資源對推廣的助益大、中心與夥伴對「夥伴關係」相互給予高度評價、夥伴有賦權及能力培養感受、產出學術成果20篇、且近乎所有機構表達計劃結束後持續推動的可能性。

Percutaneous endoscopic gastrostomy (PEG) feeding, introduced in 1980, has been a common device used in western societies for more than twenty years. However, its use is not as popular in Taiwan. The purpose of this research was to enhance PEG use through participatory action research (PAR). We set up a PEG center and developed variety of educational material, including pamphlet, poster, and video for professionals and public. Initial stage: Six agencies joined the program and took actions to enhance PEG tube use in their praxis. In the following year, 62 agencies joined the PAR program. Outcome analysis showed that in the structure dimension, most of the agencies developed policy and procedures to enhance PEG use. In the process dimension, about 6000 people received PEG information. A total of 309 PEG devices has been done by 26 agencies, and those who received PEG feeding (n=177) had better life quality (less GI bleeding, rehospitalization, and physical restraint). The average proportion of PEG use was 5.78%. Both parties appreciated the partnership built in the process. All except one partner expressed the willingness to continue the actions to enhance the appropriate use of PEG tube.

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