神經外科護理人員腦室外引流照護能力之改善

Improvement of Neurosurgery Nurses’ Care Ability for the External Ventricular Drainage

腦室外引流是神經外科常見且特有的，若照護不當會使病患處於顱內高壓、顱內出血、感染等高危險之併發症，故提供病患完善的照護，避免併發症產生是神經科護理人員應具備之基本能力，然而在臨床發現護理人員對腦室外引流相關照護不完全熟悉，以致病患產生顱內壓不穩定症狀（如劇烈頭痛、噁心、嘔吐等），以及併發中樞神經系統感染。本文乃是以「腦室外引流照護認知問卷」、「腦室外引流照護技能評核表」與「照護學習經驗調查問卷」針對腦神經科42位護理人員，對其照護認知、技能、學習資源、在職教育狀況與臨床照護困難及問題等項目，進行資料之收集與分析，結果顯示，護理人員對相關照護知識、技能不夠純熟。故針對上述問題以「課室教學」、「技能操作示範演練」等方式進行專案改善，所收集之資料以SPSS/windows 13.0 進行統計分析，經由配對t 檢定結果顯示，護理人員照護認知之正確率由67.2 ％提升至91.4 ％，標準差19.63，t 值為-7.86（p 值=0.00 <0.05）；照護技能正確率由59.2 ％提升至94.6 ％，標準差2.32，t 值為-12.71（p 值=0.00<0.05），二者均達到顯著之成效。 External ventricular drainage (EVD) is common and specific in neurosurgery, inappropriate care may usually endanger the patient in high risks of complications, such as increased intracranial pressure, intracranial hemorrhage and infection. Therefore, to provide the patients with perfect care and avoid the complications is the fundamental ability for the neurosurgical nursing staffs. However, some nursing staffs, which are unfamiliar with the care of EVD, may make the patients result in unstable intracranial pressure (such as severe headache, nausea, vomiting etc.) and complicate with central nervous system infection. In this report we provide the questionnaire for knowledge to the care of EVD, evaluation scale of the nursing skill for EVD and questionnaire of nursing care learning experience to 42 neurosurgical nurses. We collect and analyze the data for the care knowledge, skill, learning resource, refresher education and difficulty in clinical care. The results reveal that nursing staffs are not completely familiar with the care knowledge and skill. In order to improve the results, we precede a special case of instruction course and skill operation demonstration to the nurses. The data are analyzed with statistic software SSPS/windows 13.0. And paired t test is used (p < 0.05, significant) for comparison. After the special case intervention, the correct ratio for the nurses’ care knowledge rises from 67.2 % to 91.4 %﹐SD=19.63(t =-7.86, p =0.00< 0.05); and the correct ratio for the nurses’skill rises from 59.2% to 94.6%﹐SD=2.32(t = -12.71, p=0.00 < 0.05), both ratio differences are significant.

External ventricular drainage (EVD) is common and specific in neurosurgery, inappropriate care may usually endanger the patient in high risks of complications, such as increased intracranial pressure, intracranial hemorrhage and infection. Therefore, to provide the patients with perfect care and avoid the complications is the fundamental ability for the neurosurgical nursing staffs. However, some nursing staffs, which are unfamiliar with the care of EVD, may make the patients result in unstable intracranial pressure (such as severe headache, nausea, vomiting etc.) and complicate with central nervous system infection. In this report we provide the questionnaire for knowledge to the care of EVD, evaluation scale of the nursing skill for EVD and questionnaire of nursing care learning experience to 42 neurosurgical nurses. We collect and analyze the data for the care knowledge, skill, learning resource, refresher education and difficulty in clinical care. The results reveal that nursing staffs are not completely familiar with the care knowledge and skill. In order to improve the results, we precede a special case of instruction course and skill operation demonstration to the nurses. The data are analyzed with statistic software SSPS/windows 13.0. And paired t test is used (p < 0.05, significant) for comparison. After the special case intervention, the correct ratio for the nurses’ care knowledge rises from 67.2 % to 91.4 %﹐SD=19.63(t =-7.86, p =0.00< 0.05); and the correct ratio for the nurses’skill rises from 59.2% to 94.6%﹐SD=2.32(t = -12.71, p=0.00 < 0.05), both ratio differences are significant.