改善長期照護機構住民照護品質之探討－以白木耳食療處理便秘問題為例

A study of using treemella as a food therapy for constipation to improve the quality of care of the residents in long-term care institutions

傅櫻梅(F)

指導教授 ： 葉玲玲

亞洲大學/健康學院/長期照護研究所/碩士(2006年)

摘要

提昇長期照護機構的照護品質是未來發展長期照護的重要議題，便秘是機構住民常見的問題。老年人因為長期使用藥物、老化及生活習慣改變，而導致便祕。文獻亦顯示長期照護機構住民便祕的盛行率估計在50%~80%。因此長期照護住民便秘問題的處理模式就成為長期照護品質的重要的課題。現階段處理便秘問題，經常使用緩瀉劑及灌腸。然而經常使用緩瀉劑及灌腸的人，會致使胃腸運動紊亂，進而影響個人生活品質。本研究擬以白木耳飲食介入處理便秘問題，以了解長期照護機構住民便秘盛行率及機構針對住民便秘處理的照護模式，並評估白木耳食療對長期照護機構住民排便的影響。
本研究為比較白木耳食療介入前後之實驗設計，以台中某老人養護中心28位住民為研究對象，於飲食中加入一餐白木耳點心。並觀察其介入前、介入中及介入後每天之排便情形及相關的影響因素，其因素包括腸蠕動的次數及強度、胃腸藥及緩瀉劑的使用量、灌腸情況，以及住民的人口學資料。本研究共觀察11天。
研究結果顯示白木耳食療對增加腸蠕動的次數及強度有立即性的效應，亦有減少藥物使用量的功效。白木耳食療停止後功效延續情形之比較分析，可見白木耳對腸蠕動次數與強度及藥物使用量的改善均可達3天的延續性功效，所有分析結果均達統計上顯著意義。
以藥物處理排便的照護模式，雖然方便且快速，然而不適當或不必要的藥物使用所產生的副作用及灌腸對老人的感受是一種較不人性化的對待。白木耳可減少便秘照護過程對藥物的依賴，避免其對住民健康的損害，達到促進住民身體健康的目的。改善長期照護機構住民便秘的照護模式，不僅可以提升長期照護品質，亦可增進住民之生活品質。
建議應以住民為中心，發展各項生活照護準則及照護過程品質指標，作為長期照護機構照護人員的照護規範。依研究結果，建議未來機構使用白木耳，可採每隔三日食用一餐，每次300gm之方式。研究樣本較少是本研究之一大限制，但仍可作為未來大樣本研究及發展長期照護生活照護模式準則和照護品質過程指標之參考。

關鍵字

照護品質 ； 便祕 ； 食療 ； 長期照護機構 ； 生活品質

並列摘要

To improve the quality of long-term care institutions is an important issue of developing long-term care in the future. Constipation, a recurring problem of residents in the institutions, is cause by medication, ageing, and changing of life style. The prevalence of constipation of the residents is estimated to be 50%~80%; therefore, the problems of treating constipation become an essential subject of the quality of care. Laxatives or enemas are usually used for constipation; however, long-term use of laxatives or enemas results in intestinal dysfunction, and consequently affects the sufferer’s quality of living. The aims of this study are to realize the prevalence and strategy of constipation of the residents and to evaluate the treemella therapy’s impact on the sufferers’ defecation.
To compare the condition of constipation of the residents before and after the intervention of the treemella food therapy, I’ve recruited thirty residents in an infirmary care center for senior citizens in Taichung, Taiwan as the subject of this study. Adding extra refreshment made of treemella to their diets, we’ve observed, in a course of 11 days, their daily defecation before, during, and after the intervention of the treemella food therapy and other relevant factors, including the times and the intensity of bowel action, the quantity of using peristaltic and laxatives, the use of enemas, and the demography information of the inhabitants.
The consequences have shown that the intervention of the food therapy made of treemella had an instant influence on the times and the intensity of bowel action and had an effect on reducing the amount of medication. These results last for 3 days, which achieve statistically significance.
The model of treating constipation with medication is quick and convenient; nonetheless, the side effects of using improper or un- necessary medication and the feeling of having enemas is a kind of inhumane treatment. Treemella may decrease the usage of medication during the constipation care, and avoid harming the residents’ health. Improving the caring model of constipation of the residents can not only raise the long-term care quality but also improve the residents’ quality of living.
I suggest that we develop, based on residents-centered views, varying standards of living care guidelines and quality indicators of long- term care, which could be followed by the caregiver. Our results have indicated the improvement of the residents’ defecation. I recommend that treemella be added to the diets of the inhabitants, which can be done as the following instructions: one meal for every three days, 300gm per time. This study is limited because of the sample collected; nevertheless, it could be of reference to the future research with a larger-scale of research, for developing the guidelines and indicators of quality of long-term care.

並列關鍵字

quality of care ； constipation ； food therapy ； long-term care institutions ； quality of live

參考文獻

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