手術室護理人員執行全膝關節置換術病人術前護理指導改善專案

A Project for Improvement of Preoperative Nursing Guidelines Conducted by Operating Room Nursing Stafffor Patients Undergoing Total Knee Replacement

本專案旨在改善手術室護理人員對全膝關節置換術病人術前護理指導作業之缺失。經現況調查發現：欠缺全膝關節置換術前護理指導作業標準，護理人員對於護理指導內容不瞭解，其護理指導完整率僅43.4%；病人對術前護理指導滿意度為2.4分（滿分5分）及對術前護理指導需求為4.9分（滿分5分）。經由實地觀察、現況分析及文獻查證後，進行解決方案：一、舉辦教育訓練課程及宣導；二、建立術前訪視護理指導作業標準與監測工具；三、執行術前護理指導的訪視服務。經實施解決方案後，護理人員執行護理指導完整率達96.7%，且病人對護理指導的平均滿意度為4.9分（滿分5分），顯示本專案確實能有效提升術前護理指導作業品質並達專案目的。The aim of this project is to seek and improve any drawback in the present preoperative nursing guidelines conducted by operating room staff for patients undergoing total knee replacement. Two main problems were found in our investigation. First, there is a lack of complete preoperative nursing guidelines for the surgery. Second, thorough understanding of the present guidelines among the staff is low. We also found that only 43.4% of the staff carried out the guidelines. Patient's satisfaction index for the guidelines was 2.4 (0 to 5). Index for patient’s demand for the guidelines was 4.9 (0 to 5). After analysis, integration, and review of literatures, three improvements were proposed: 1. implementation of in-service training program on specific topics, 2. revising the present guidelines and establishing a monitoring system, 3. encouraging preoperative nursing consultation. Our results showed that the percentage of the staff carried out the new guidelines was raised to 96.7%, patient's satisfaction index for the new guidelines was improved to 4.9 after the three improvements were carried out. We concluded that our project can effectively improve the preoperative nursing quality in patients undergoing total knee replacement and can fulfill the goal of an improvement project.