護理人員壓瘡預防行為之系統性文獻查證

A Systematic Review of Nurses’ Prevention Behavior with Pressure Ulcer

目的：本研究主要探討影響護理人員壓瘡預防行為之相關因素。方法：透過全國碩、博士網站資料庫相關論文、CEPS中文電子期刊、CETD電子學位論文、ProQuest Nursing and Allied Health Source護理學期刊全文資料庫、Pub Med、Academic Search Premier ASP學術綜合類全文資料庫自1995年6月至2012年5月之發表期刊為主，使用關鍵字有三：護理人員、壓瘡、預防行為，且內文須同時含影響護理人員壓瘡預防行為之橫面研究或專案，方列為分析之文獻。經由文獻查證到372篇，符合設定條件共15篇，其中中文七篇，英文八篇。結果：影響壓瘡預防行為的因素包括：年齡、教育程度、工作年資、是否參加壓瘡研習課程與閱讀壓瘡相關文獻、工作時數、工作負荷、預防壓瘡知識與態度。結論：雖然大部分護理人員認為壓瘡是可以避免的，但卻未必能執行壓瘡預防行為，可能的障礙因素包括人力不足、超時工作、病人之特殊狀況、缺乏輔具與設備。壓瘡預防是一個多元問題，若醫療團隊不重視此問題，只由部分工作人員來執行只會事倍功半，另外人力不足會導致工作負擔過重，以致無法將壓瘡預防列為優先辦理項目。未來可透過數位學習加強護理人員壓瘡認知、鼓勵護理同僚能將壓瘡預防列為執行之優先項目、適當運用輔具協助病人重新臥位等措施，來促進護理人員壓瘡預防行為之產生。

Purposes: The purpose of this study was to investigate nurses’ preventive behavior with regard to pressure ulcers. Methods: We searched theses and dissertations in Taiwan, CEPS, CETD, ProQuest Nursing and Allied Health Source, Pub Med, and Academic Search Premier from June 1995 through May 2012 to identify relevant key words (staff nurse, pressure sore and prevention behavior), and specific papers or projects related to pressure ulcer prevention, and found 15 papers (seven papers in Chinese, and 8 in English) among 372 possible articles. Results: The findings were as follows: influential factors in preventive behavior were age, educational level, work unit, attendance at in-service education and reading related articles, work hours, work load, and knowledge and attitude about preventive behavior. Conclusions: Most nurses thought that pressure ulcers could be avoided, but they could not consistently implement preventive behaviors. Perceived barriers to carrying out pressure ulcer preventive behavior were lack of staff, lack of time, patient specific problems, lack of mechanical aids and equipment. Pressure ulcer prevention is a multidisciplinary problem. If all members of the team do not contribute fully, then the result is half the work with twice the effort. Staff shortages result in overstretching of staff at the clinical level, and they are then unable to set priorities for implementation. The study suggests that strategies to improve this problem might include improving staff knowledge via e-learning, encouraging peers to show priority in implementing preventive behavior, and repositioning patients with aids, therefore reinforcing behavioral change with regard to pressure ulcer prevention.