南部某醫學中心推動肝臟移植手術全期護理照護模式之成效

Standardization of Perioperative Liver Transplantation Nursing Care at a Medical Center in Southern Taiwan

本專案旨在推動肝臟移植手術全期護理照護標準，由現況發現，術前護理訪視作業標準及術前訪視護理指導單內容不完善、缺乏術前護理訪視指導手冊、在職教育訓練不完整、未制定手術中防護措施照護標準、手術中防護輔具不完善等原因，造成肝臟移植手術全期護理照護不完整。提出改善方案：制定術前護理訪視作業標準及護理指導手冊、修訂術前訪視護理指導單、舉辦在職教育訓練、制定手術中防護措施照護標準及改善手術中防護輔具。經本專案改善後，術前護理訪視服務整體滿意度由86.8％提高為96.6％，手術中病人皮膚受損、垂足及腿部神經損傷的情形未再發生，且手術過程中病人的體溫皆能達到36℃以上，可知提供適當的防護輔具，可以避免手術中的傷害。期望藉由推動肝臟移植手術全期護理照護模式的經驗，讓病人能接受優質的服務，並能提升手術室護理人員之專業照護能力。

This study aims at improving perioperative nursing care in liver transplantation. Both the standard of the perioperative nursing care and the nursing guide were found to be far from perfect. Lack of a perioperative nursing care manual, patient preoperative information booklets, professional educative training, operative protection standards, and protective materials contributed to inadequate perioperative nursing care in liver transplantation. In order to improve the quality of nursing care, a nursing guide manual was established after conducing a survey among all operating room (OR) nursing staff involved in liver transplantation. This manual was revised and improved based on a second serial OR nursing survey. A training program was established based on this manual to standardize perioperative nursing care. The manual also included standard patient protective measures during liver transplantation. New protective materials were obtained and used in the new protocols. The two surveys included a satisfaction survey to evaluate OR nurses’ opinion about the standard care. The satisfaction level elevated to 96.6% from 86.8%. Patient injuries (skin damage, drop foot, nerve damage of the lower extremities, and hypothermia) were no longer seen after standardization of nursing care. Standardizing and improving perioperative nursing care with manual based educative training program not only lower the risk of injuries to patients in liver transplantation but also increase overall nursing work satisfaction.