降低胃腸科病患尿布性皮膚炎發生改善方案

The Project Report of Reducing Diaper Dermatitis in Gastrointestinal Ward

皮膚完整性照護是護理人員關心的議題，它亦代表著護理人員的照護品質。胃腸科病房屬成人病房，病患多為年老、腸胃道炎症或出血、解血便及使用治療性瀉劑的病人，病患經常需要使用尿布。自87年11月至88年3月收集臨床使用尿布病患51位，其中發生尿布性皮膚炎者有19位，發生率為37.2%。為降低尿布性皮膚炎發生，參考文獻及臨床照護經驗，制定護理人員對使用尿布病患的照護標準及發展照護記錄表。照護標準內容採內容效度檢定，效度達0.9；人員依照護標準照護病患，單位主管及護品股依照護記錄表記錄的內容及臨床病患使用尿布情形，監測人員執行狀況。自88年4月實施至9月，收集使用尿布病患共48位，比較改善前後二組病患基本屬性資料，除性別有差異外(p < 0.05)，年齡、疾病分布、 身體活動度、腹瀉以及大小便失禁情形並無顯著差異(p > 0.05)；改善後，人員對病患的尿布更換頻率與改善前有顯著差異(p < 0.01)；48位病患中，有7位發生尿布性皮膚炎，發生率為14.6%，較改善前發生率37.2%有顯著下降(p < 0.05)。

The skin integrity is a major issue for nurses because it implied the quality of nursing care. Patients who are admitted to the gastrointestinal unit often suffer from inflammation or bleeding of gastrointestinal tract and receive laxative treatment. As a result, this survey was conducted from November 1998 to March 1999 to explore the incidence of diaper dermatitis. Of 51 patients who used diaper, 19 (37.2%) had diaper dermatitis. According to the literature and clinical experience, a nursing intervention protocol and nursing care checklist were developed to evaluate the incidence of diaper dermatitis. The content validity index of the nursing standard is 0.9. During April 1999 to September, 48 patients who used diaper were recruited and received the designed protocol and checklist. Of these two groups (51; 48), there is no difference on age, diagnosis, mobility, diarrhea and incontinence between the control and treatment group (P > 0.05). After applying the designed nursing care checklist, the frequency of changing diaper is significantly increased (P < 0.05). Of 48 treated patients, only seven (14.6% ) had diaper dermatitis. The incidence is significantly reduced from 37.2% in control group (N=51) to 14.6 % (N=48) in treated group (P < 0.05).