加護護理人員對實證氣管內抽痰術認知及技能之關係

Nurses’ Knowledge and Skill Toward Evidence-Based Practice of Endotracheal Suctioning in Adult Intensive Care Unit

本研究為敘述-調查性研究，旨在探討加護病房內護理人員氣管內抽痰術認知及其技能之關係。由中區三家醫院護理部統計375 位成人加護病房全職護理人員數以6：1 系統隨機抽樣方式抽出63 位成人加護病房全職護理人員為研究對象。研究工具為研究者自擬實證氣管內抽痰術認知問卷與技術評量表與個人屬性表。研究結果發現：護理人員氣管內抽痰術技術得分為23.95（±4.95）（總分55分）屬中等偏低程度，護理人員氣管內抽痰術認知程度與其實際技能程度沒有相關（r=-0.025，p>0.05），心肺加護病房、教學醫院與大學制護理教育畢業者有較優的抽痰術技能。加護人員所在的加護病房別、護理教育程度與使用過度氧合頻率是氣管內抽痰術重要解釋因子，累積解釋39％抽痰技術的變異量。對於抽痰術前、後期防範抽吸相關缺氧的過度氧合處置、抽痰前洗手、抽吸管太快抽離、使用過多負壓與生理食鹽水氣管灌洗與抽痰後期詢問病人感受等項目是未來在職教育的重點。護理的應用上，包括增加加護人員對實證氣管內抽痰術在職教育之需要。翻新實證氣管內抽痰術操作指引，並能定期確實抽痰術品質評量，以確保護理人員對抽痰術認知與技術能力的持續性。

This descriptive study examined the relationship between ICU nurses’ skills and knowledge of evidence-based practice of endotracheal suctioning (ETS). A system random sample of 63 participants consisted of adult intensive care unit nurses were recruited from three hospitals at the middle Tai-Chung area in Taiwan. Structured questionnaires of demographics, ETS skill and knowledge questionnaire were developed by the researchers to examine ICU nurses’ knowledge and their actual ETS practices during procedures of ETS, their preventions of hypoxia and management of complications of ETS. The results indicated that participants had a mean score of ETS 23.95 which was considered as medium lower on standardized score. There was no correlation between nurses’ knowledge and their actual skill of ETS (r=-0.025, p>0.05). Type of ICUs, education level of nursing, and frequency of using hyperoxygenation were important explanatory factors accounting for 39% of variance of ETS scores. These findings suggested that continuing education needs in updated knowledge of hyperoxygenation, washing hands before ETS, suctioning tube insertion and normal saline irrigation during ETS, and interaction with patients after ETS. Renewing procedure guideline of evidence-based ETS, and continuous monitoring of ETS were important to ensure continuity of ETS knowledge and skill ability of ICU nursing staff.