提升精神科急性病房護理人員交班內容之完整率

Improving Completeness of Nursing Shift Reports of Acute Psychiatric Ward

護理交班之目的在於提供病人的重要訊息和照護指引，以維持連續性的照護品質。本案以南部某地區精神科專科教學醫院之急性病房的護理人員為對象，分析現況發現：交班內容完整率僅50％，其中以『下一班優先處置』之交班項目為最差，其次為『評值』項目。經原因分析確立問題為：1.無交班作業規範提供護理人員依循，現存交班單內容不足；2.護理人員對交班內容認知不足：強調身體層面處置和醫療輔助行為；3.人員流動率高，一年內的新進人員佔1/3；4.未將交班列入人員訓練及品管稽核，故成立專案小組以改善交班內容的完整率。以自擬交班查檢表做為專案進行前後評值的工具，改善策略有教育訓練、訂定交班作業規範、交班單及建立品管稽核標準等。結果：護理人員交班內容完整率為88.8％。教育訓練中運用護理過程概念、訂定交班作業規範和護理交班單，可突顯護理交班之專業角色，提升交班完整率並達交班的共識，協助新進人員適應。未來可將護理交班納入教育訓練，提升交班水準。

Purpose of nursing shift change is to provide patient’s vital information and care guidance to maintain consistent nursing care quality. This research recruited nursing staff of an acute psychiatric ward from a psychiatric teaching hospital in southern Taiwan as subject. After analysis, we found that content completeness of shift notes was only 50%, and “Next shift priority” was rated the worst, following the item of “evaluation”. Through further analysis, the causes of the problems included: (1) no standard operation procedure for shift handover and contents for existing nursing notes were inadequate; (2) nurses’ recognition for shift change was inadequate, too much emphasis was given to physical body level handling and medical assistance behavior; (3) high turnover of nursing staff, with one-third of nursing staff were new to the department; (4) shift handover was not incorporated into staff training and quality assurance compliance. The aim of the project was to improve completeness of shift change reports. This project produced a shift change inspection list as an appraisal tool for pre- and postevaluation. Improvement strategies included education training, prescribing shift change operation standard, and establishing quality control compliance standards, etc. Completeness of nursing shift reports reached 88.8% after implementation. Improved shift change completeness and shift change consensus also assisted new staff fitting into the new environment. Nursing shift change should be incorporated into educational training programs to improve the standard of nursing shift reports.