股骨骨折病患延遲下床時間的探討

Searching the Factors Leading to Delay on Initiation to Leave the Bed for Postoperated Patients Suffering from Femoral Fracture

股骨骨折的患者在接受適當的手術處理之後，早日康復的要素在於及早下床與及早復建。然而，錯誤的觀念與惰性的使然，常令患者、家屬與護理人員忽略了早期復健的重要性。術後首次下床時間為早期復健的指標；我們的患者術後首次下床的時間為141±4.9 小時，明顯延遲。探究其因，患者「不知何時可以下床」（44.3%） 與「缺乏專業協助」（37.7%），而護理人員誤以為「患者與家屬會自理」（34.2%），坦承「移位技術不熟練」（28.9%），而且「未做適當的稽核」（22.1%），都是亟待改善的。我們認為，透過統籌的規劃、周全的稽核、持續的在職教育、適當的復建計劃與床邊溫馨的醫病溝通，才能澈底解決問題；這是我們後續要做的工作。

For the sake of early recovery of postoperated patients suffering from femur fracture, the patients should be encouraged to leave the bed as early and to receive rehabilization as soon as possible after the surgical manipulation. However, the patients, their family and even the nurses used to have misconcepts either socially or professionally, so that postoperative rehabilization was not accepted to perform as early here in Taiwan. We found that the initiation time to leave the bed (the t-time) for the postoperated femur-fractured patients was usually so postponded to 141±4.9 hrs after surgery in our ward, although the t-time was an important index of postoperative rehabilization. The factors leading to such a prolonged t-time included:“not knowing when to leave the bed”(44.3%)、and “lacking professional aid(s)”(37.3%) for the patients and/or family, but“supposing patients and family able to do it themself”(34.2%)、“lack of professional skill(s) ”(28.9%)、and “no supervision”(22.1%) for the nurses in the present study. Hence, we need to build a new system, a complete plan, to involve an active supervision、a continuous training course、a suitable rehabilization structure、and a close nurse-patient’s relationship, to make sure the postoperative femur-fratured patients recovering as soon.