化學治療病患接受護理指導之改善方案

Improving Nurse Monitoring for Cancer Patients Receiving Chemotherapy

本專案係針對化學治療病患接受護理指導之作業缺失加以檢討改善，加強護理人員對化學治療護理指導之執行，以提升病患對化學藥物及副作用之瞭解。由現況分析中得知，導致化學治療護理指導比率偏低之原因，於護理人員方面：表示缺乏化學治療中評估工具、缺乏化學治療藥物衛教單張、副作用衛教單張不完整及對護理指導方式滿意度偏低僅46%；於制度方面：未建立化學治療護理指導作業標準，包括未設立化學治療中評估工具、未訂定明確的作業流程及持續性護理指導監控作業等，於病患方面：接受衛教單張及護理指導者僅佔30.1%，且護理指導後皆未接受評值其瞭解程度。故藉由改善方案一：建立完善之化學治療護理指導作業標準，包括設立化學治療中評估工具、增設化學藥物及副作用衛教卡片，製訂化學治療護理指導作業流程供人員遵循，並依病患個別性需求提供化學治療護理指導，再透過監控作業以瞭解護理人員執行的情形，最後於病患出院當日評值其接受護理指導之瞭解程度及需求滿意程度，以作為臨床護理指導改善之依據；改善方案二：安排護理人員在職教育課程，以加強護理人員對化學治療護理指導的認知。經專案改善實施後，護理人員對護理指導之執行率達96%，較改善前提升42%；護理人員對化學治療護理指導方式平均滿意度為88%，較改善前提升42%，且達統計上顯著差異(p < .01)。另病患對護理指導需求獲得滿意程度平均得分為4.07分（滿分5分），顯示所提供之護理指導可滿足病患的需求。由此可知，透過建立完善的化學治療護理指導作業標準及加強護理人員在職教育課程，對於提升臨床護理指導確有其效益。

The purposes of this project were to develop and implement standards of care that guide nurses when caring for cancer patients getting chemotherapy and to improve patients' understanding about side effects and complications of chemotherapy. According to available data, the reasons for lack of appropriate education and assessment of chemotherapy patients by nurses may due to lack of assessment tools, lack of patient education materials, lack of educational materials that give complete information about side effects, and low patient satisfaction (46%). In addition, lack of standards, lack of clear procedures, and lack of continuous monitoring were found. Only 30.1% of patients received appropriate monitoring by nurses and most of the patients were not assessed for their understanding of chemotherapy and its effects. These findings led to a project aimed at making two improvements. First, nursing care standards for cancer patients receiving chemotherapy were developed. Based on these standards, assessment tools, side effects education cards, and nursing procedures were developed. Individualizing patient care was emphasized as was continual assessment of patients' understanding. Finally, patients' understanding and satisfaction were surveyed to serve as feedback for further improvement of standards and procedures. Second, arranging continuing education for nurses was implemented to increase nurses' knowledge of chemotherapy. After implementing the programs, nursing assessment and monitoring increased from 54% to 96%. The average patient satisfaction increased significantly (p< .01) to 88%; the satisfaction score was 4.07 on a 5-point scale. In summary, the quality of nursing care improved by establishing nursing standards and procedures and requiring continuing education for nurses. This project effectively improved nurse monitoring of cancer patients receiving chemotherapy.