提昇某院腹膜透析病人自我照顧能力之專案

Enhancing the Se1f-care Ability for Peritoneal Dia1ysis Outpatients in a Regional Teaching Hospital

腹膜透析是末期腎病變患者賴以生存的治療方式之一，而感染是腹膜透析患者最常見的合併症，故本專案皆在提升腹膜透析病人自我照顧能力，以減少合併症發生。專案小組於2010年3 月l 日至10 日以問卷方式調查30位腹膜透析病人，結果發現病人自我照顧能力學習成效答對率僅72.0% '其原因為：回診時問太短沒有時間詢問護理人員、教導方式不一致、衛教內容看不懂、缺乏技術練習及缺乏飲食控制、健康行為、症狀控制等知識；經由更改回診流程、制定自我照顧標準規範、制定飲食、技術、居家自我照顧等衛教指導單張、增加換液換藥技術評核次數、評核自我照顧認知，使病人自我照顧能力學習成效答對率從72.0%提升至92.3% '實施此專案之後本院腹膜炎發生率從21.5次降低至7.6次/100人月，因此希望此專案成果能推廣至所有腹膜透析病人，讓病人學習並擁有正確之自我照顧能力，得以杜絕成染合併症的發生，進而提升透析病人的生活品質！Peritoneal dialysis (PD) is one of the treatments for patients with end-stage renal disease (ESRD) to survive. Since infection is the most common complication during the PD process of outpatients, the purpose of this project is to enhance the self-caring ability in our patients to reduce infection and other PD related complications. By using a structured questionnaire, our project team surveyed thirty PD outpatients from March first to March tenth of 2010. The result showed that only 72.0% of the participants answered the questions on self-care ability correctly. Analysis of the problem revealed time shortage in discussing the self-care issues with the primary care nurses; teaching methods were inconsistent; they had difficulties to understand or misunderstood the educational issues; they lacked self-care practicing skills; they had limited knowledge on diet control; and they had inappropriate health behaviors, etc. Thus, we initiated a change in outpatient clinic flow chart, established a standard self-care PD procedure for PD patients and helped them in performing standardized aseptic self-care procedure at home. We also created educational materials regarding the PD procedure practicing and home care, diet control, etc. Furthermore, trained nurses evaluated the PD patients' skills on exchanging fluid and knowledge on appropriate self-care more frequently at outpatient clinic. Ultimately, the skill and knowledge on appropriate self-care in our outpatient PD patients improved from 72.0% to 92.3%. After the implementation of our project, the rate of peritonitis in outpatient department decreased from 21.5 to 7.6 per 100 patient-month. Thus, we hope this project may benefit all the peritoneal dialysis patients, allowing them to obtain appropriate self-care ability with the hope of reducing the infectious complications. Finally, this project improved the quality of their lives!