精神科住院病人口腔衛生不良改善方案

Oral Hygiene Improvement Project for Psychiatric Inpatients

口腔衛生易被精神病人所忽略，國內、外研究發現精神病人口腔健康問題普遍嚴重，有迫切做預防性改善措施的需要。本專案旨在改善精神科急性住院病人之口腔衛生。專案執行前，由入院護理評估發現病人有齒垢、牙齦萎縮、蛀牙等口腔健康問題，分析乃因病人衛生習慣不好、認知偏差、以及護理人員未將口腔衛生納入護理常規等因素造成。經由將病人口腔衛生列入常規護理、口腔衛生指導、定時提醒刷牙等改善計劃，並列入出院計畫，請家屬持續提醒病人養成習慣，結果病人口腔衛生評估之分數由4.0分降至1.3分，超過目標值2.0分。第三、四級牙菌斑級數由91.0％降低至13.0％，超過目標值48.6％，第一、二級牙菌斑由9.0％提昇至87.0％，超過目標值17.0％。由改善結果發現護理人員只要在常規工作中加入適當的衛教，病人口腔衛生是可獲得顯著的改善。

Psychiatric patients often ignored their oral hygiene. Studies indicated that poor oral hygiene is a common and serious problem among psychiatric patients and is needed to be prevented and intervened. This project aimed to improve oral hygiene of inpatients with acute psychosis. Prior to the implementation of this project, the authors concluded three common oral problems based upon patients’ nursing admission assessment. They were plague, decayed tooth, and gum receding. Data analysis showed that those problems were mainly caused by: (1) poor oral self-care; (2) cognitive distortion due to illness; (3) the oral hygiene education has not included in nursing care routines. The authors set up a systematic plan of oral hygiene improvement project that consisted of routine care for oral hygiene, psycho-education for proper tooth cleaning techniques, reminding patients of what they learned for oral cleaning, family’s assistance in reminding patients of proper oral hygiene and combining the oral hygiene education with discharge plan. The results of this project showed that the score of patients’ oral hygiene decreased from score 4 to score 1.3, which is higher beyond the expected score of 2.0. Also, patients’ plaque significantly improved: grade III and IV improved from 91% to 13%; grade I and II increased from 9.0% to 87%. The outcomes of this project indicated that incorporating psycho-education program of oral hygiene in daily nursing routine care could produce significant improvement.