氣切造口病人手術後需求的溝通障礙改善專案

Improvement of Communication Disturbance for Patients' Needs Post Tracheostomy Surgery

由於治療或疾病的因素必須留置氣切造口，而氣切造口病患因為無法發聲經常出現溝通上的問題。本專案目的為(1)降低氣切造口術後病患因需求所需溝通的發問次數，(2)降低氣切造口術後病患因需求所需溝通的花費時間，(3)提升氣切造口術後病患對溝通的滿意度。現況中發現因缺乏合宜的溝通工具，缺乏術前溝通衛教，護理人員缺乏氣切病患術後照護計畫表，而造成氣切造口術後病患因需求所需溝通的發問次數為35.68次，發問所花費時間為28.55秒，病人對護理人員術後溝通之滿意度為3.09分，故進行下列之改善：(1)製作圖片板，(2)安排術前溝通衛教計畫，(3)設立氣切病患術後照護計畫表。改善結果(1)氣切造口術後病人發問次數由35.68次縮短至23.76次，以相依樣本t檢定(paired t-test)檢定改善方案執行前後整體發問次數之差異，達統計上顯著差異(t=6.922, p＜0.001), (2)氣切造口術後病人表達發問所花費時間由28.55秒縮短至20.06秒，達統計上顯著差異(t=2.58, p＜0.05), (3)氣切造口術後病人對溝通的滿意度由3.09分提升到4.52分，達統計上顯著差異(t=-5.927, p＜0.001)。以上均達專案目的所設定之目標。因此，本專案之改善，確實有效的提升氣切造口術後病患與護理人員的溝通。

The disease or treatment factors due to be tracheostomy, because of giving off sound unable that patient had communication problem. The purpose of the project to (1)improve the time of asking questions for patients post tracheotomy surgery, (2)improve the cost times of asking questions for patient post tracheotomy surgery, and (3)promote the satisfactions of communications for patient post tracheotomy surgery. Before the improvement program, we found the Patient Post Tracheotomy Surgery need to ask about 35.68 times and spend 28.55 second for every time they ask questions. And their satisfaction of communication is only 3.09 according the total score of 5. The reason of causing this is because we lack of suitable communication tools and instructions, and related curriculum trains. Therefore we carry on following of improvement: (1) manufacture picture plank for communications, (2) arrange pre-operation education program, (3) draft the communication care protocol for post tracheotomy surgery. After the improvement program, (1) The number of times of sking questions for patient post tracheotomy surgery reduced significantly to 23.76 times (t=6.922, p<0.001); (2) cost times of ask questions for patient post tracheotomy surgery reduced significantly to 20.06 seconds per each time (t=2.58, p<0.05); (3) The satisfaction of communication for patient post tracheotomy surgery is increased significantly to 4.52 (t=-5.927, p<0.001). All of these improvements are reach the goal of this project. Therefore, these improvements of this project promote the communication really effectively between nurses and patient post tracheotomy surgery.