提升居家主要照顧者壓瘡照護技能正確率改善專案

A Project to Promote the Accuracy of the Home Caregivers' Care Ability for Pressure Sores

居家主要照顧者在長期照顧個案服務中，是主要的服務提供者，而具有良好的照顧技能能避免居家個案合併症發生。居家護理師於訪視時發現新收個案壓瘡發生比率高佔64.76%，故成立專案小組以了解居家主要照顧者壓瘡照護之能力及現存之問題。於2008年2月至4月實地查核105位居家主要照顧者壓瘡照護情形，發現居家主要照顧者皮膚照護認知僅達66.67%、執行個案翻身擺位正確率僅51.64%及執行壓瘡傷口照護正確性僅達64.38%，經現況分析得知原因為：居家護理師未落實執行壓瘡照護護理指導、居家主要照顧者壓瘡照護認知不足、執行個案翻身擺位不正確、壓瘡傷口照護技能不足及缺乏壓瘡評估工具及防壓輔具等。故製作居家壓瘡皮膚評估單、居家壓瘡皮膚評估測量尺、居家防壓輔具、翻身擺位VCD及進行居家主要照顧者技能指導及回覆示教，舉行居家護理師壓瘡照護在職教育訓練，經過5個月改善措施推動，結果：居家主要照顧者皮膚照護認知由66.67%提升至95.13%、執行翻身擺位正確率由51.64%提昇至95.03%、壓瘡傷口照護正確率由64.38%提昇至80.21%，並運用影音光碟作為語言溝通困難者衛教指導之媒介，達專案目標。本專案結果可提供給相關照護單位參考，共同提升居家個案之照護品質。Home caregivers are the main service provider, but those who have the good attendance skill are able to avoid the occurrence of home case complications. Home nurse visits were found 64.76 percent of pressure sore cases. Therefore, a group was set up to understand the home caregivers' care ability to pressure sore care and more problems. During the peiord February-April 2008, among the 105 major caregivers of pressure sore care, knowledge of skin care was 66.67 percent. The accuracy of the turn over positioning was 51.64 percent. The accuracy of pressure ulcer care was 64.38 percent. The major reasons are as follows. First, home care nurses did not carry out the pressure sore patient guidance thoroughly. Second, home caregivers lack knowledge of pressure sore care. Third, implementation of turn over positioning is not correct. Finally, there are lack of pressure sore care skills and pressure sore assessment tools and aids, such as anti-pressure. Therefore, productions of single-home assessment of pressure sore skin, sore skin and assessment of home pressure measurement scale, home aids anti-pressure, turn over positioning, VCD and primary caregivers for home instruction, demonstration to teach the participants skills to hold pressure sore care, and home care service teacher training were implemented. After 5 months of improvement, the results show that home caregivers' knowledge skin care increased from 66.67% to 95.13%, implementation of the turn over positioning accuracy increased from 51.64% to 95.03%, the accuracy of pressure ulcer care increased from 64.38% to 80.21%. The project also used video and music discs as a medium of the instruction for the language communication difficulty participants in order to achieve the project objectives. Results of this project can provide a reference for the relevant care units to upgrade the quality of care for home care cases.