北市某區域醫院護理人員使用輔具協助病人轉移位現況探討

A Study of Assisted Patient Handling and Transfer in a Regional Hospital in Taipei City: Experience in Nursery Practice

本研究目的為1.瞭解某區域醫院護理人員協助病患執行各項轉移位活動概況，包含：頻率、自覺費力程度、是否使用輔具及使用輔具類型、執行人數；2.瞭解某區域醫院護理人員執行轉移位活動之數目、執行各項轉移位活動之轉移位方式、及執行轉移位活動之負荷程度。本研究採描述性設計，以問卷蒐集資料。採方便取樣，以北部某區域醫院及醫院附設護理之家年滿二十歲、且為現任臨床護理人員為研究對象。研究問卷包含基本資料及協助病患轉移位二部分，以再測信度分析，協助病患轉移位部分之信度為.75。統計方法包括百分比平均數t-test、one-way ANOVA、及皮爾森相關分析。研究結果為1.床上移動位置、床上翻身、床上平躺坐起、從床移到另一張床等與床相關的轉移位活動執行比例最高，高於90%；2.四個床上活動於各科執行比例皆大於70%，復健科執行比例為各病房單位第一位；3.護理人員評比自覺費力之轉移位活動項目，以床上移動位置為最費力之轉移位活動，負荷程度38.19 ± 40.43分。4.使用之輔具以非動力輔具為主，最常使用之輔具為床單／布中單、轉位滑墊／滑板、及電動床。本研究結論為床上翻身、床上移動位置、協助床上平躺病人坐起、從床移到另一張床，及協助無法坐起的病人從床移位到椅子／輪椅上、協助從地上起身，此六項活動皆為負荷程度最大、單次費力程度最高，需列為改善執行方式之重點活動。醫療機構應提供適切輔具及輔具使用技巧，教導正確轉移位技巧是當務之急，並儘速汰換不建議卻為臨床常用之床單／布中單，減少造成護理人員肌肉骨骼不適之因子。

Objectives: 1. Gain an overview regarding the application of assisted patient handling and transfer by hospital-based nurses in Taiwan in terms of frequency, self-reported exertion, the use (and type, if used) of assistive device, and the number of person engaged; 2. explore the incidence, the degree of loading, and the methods of patient transfers performed by nurses. Methods: it is a descriptive study to collect data via questionnaires on nursing professionals older than 20 years who are working in the regional hospital and its affiliated nursing home in northern Taiwan through convenient sampling. The questionnaire includes demographic information and cognition of patient handlings. The data underwent test-retest reliability analysis, Cronbach's α 0.75. Statistical analysis includes t-test on mean of percentage, one-way ANOVA, and Person correlation. Results: 1. Four items that related to beds are the highest number of activities for patient handling (above 90%); 2. Four activities on bed are all higher than 70% in all departments. However, the rehabilitation department executes the highest number of each activity among all ward units; 3. The self-assessment on exhaustion shows that the most exhausting patient handling are the activities that are carried out on bed (38.19 ± 40.43); 4. Most of the facilitating tools are not automatic. Tools commonly used are sheets, translocation pads/boards, and electrical hospital beds. Conclusions: rolling, repositioning, and sitting up from lying on a bed, transfer from bed-to-bed, transfer from bed to chair for those unable to sit up as well as rise up from the floor, are the six activities involved with the highest loading and exertion that need special attention. To reduce the risk factors leading to musculoskeletal disorders of nurses, it is important for hospitals to provide suitable assistive devices or their instructions for use, demonstrate correct handling/transfer techniques, and replace bed linens which are commonly used but not recommended for practice.