提升化學治療合併放射線療法之口腔癌患者口腔護理指導執行率

Improving Execution Rate of Oral Nursing Care Teaching for the Patients with Oral Cancer during Chemo-radiotherapy

口腔癌患者接受化學治療合併放射線療法，常因口腔黏膜改變產生疼痛不適及進食困難而想放棄治療，本單位調查2006年1月至6月於耳鼻喉科病房接受化學治療合併放射線療法之口腔癌患者126位，發現有115位出現口腔黏膜改變，其發生率為91.27％。經分析後確認問題包括未舉辦口腔護理相關在職教育、未建置口腔癌患者之口腔護理標準步驟、缺乏口腔護理用具及實際操作口腔護理指導工具。因此成立本專案，目的在提升護理人員口腔護理指導執行率、口腔護理認知程度及提升病患對護理人員執行口腔護理指導滿意度。解決方案包括：(1)建立化學治療合併放射線療法之口腔癌病患完整口腔護理標準步驟、設置病患使用之「特殊口腔護理包」及製作「口腔護理指導示範光碟」；(2)舉辦口腔護理相關在職教育課程，指導護理人員認識口腔癌及其治療、接受化學治療合併放射療法病患口腔護理指導重要性。專案實施後護理人員確實執行口腔護理指導率由54％提升至100％、口腔護理認知成績由66.5分提升至92.5分，且病患對護理人員執行口腔護理指導滿意度由52.8％提升至90.2％，達成專案目的。本專案結果及特殊口腔護理包工具未來可推廣至其他科別接受化學治療或放射線療法之癌症病患，以提升臨床護理品質並增加病患舒適。

Oral cancer patients who were treated with chemo-radiotherapy often tended to give up from this therapy because they had to suffer pains and experienced difficult eating due to altered oral mucous membrane. One hundred and twenty six patients with oral cancer who accepted chemo-radiotherapy from E.N.T. unit were investigated during a six-month period from January 2006 to June 2006. It was found that 115 patients had altered oral mucous membrane. The incident rate was 91.27%. Several problems were identified after the data analysis. The nurses were not included in the continuing education programs, specifically in oral nursing care; the standardized procedures for the care of patients with oral cancer were not in place. There was also a lack of oral nursing care and teaching instruments. The team decided to design a project to solve the above mentioned problems. The purposes of this project were to improve the execution rate of oral nursing care teaching, knowledge of oral nursing care for nurses, and patients’ satisfaction rate. The strategies to resolve these issues included (1) to set criteria for the standardized execution procedures on oral nursing care, set specialized oral nursing care package, and to create educational materials for oral nursing care teaching, (2) to conduct professional continuing education programs related to oral nursing care for nurses, to teach nurses the knowledge of oral cancer and therapy, and to help patients understand the importance of oral nursing care. The results showed that the execution rate of oral nursing care teaching increased from 54% to 100%. The average score of oral care knowledge test on nurses improved from 66.5 points to 92.5 points. Patients’ satisfaction rate improved from 52.8% to 90.2%. The results demonstrated great improvement. The results and instruments of this project could be used as an example for other departments caring for cancer patients to promote the quality of nursing care and increase patients’ comfort.