改善學齡期重症病童表達訊息之溝通模式

Practical Strategies to Improve Communications with School-Aged Children in the PICU

背景：兒科加護病房病童因疾病因素進行插管治療時，影響病童表達其需要，本專案使用自擬觀察紀錄表，並採用實際觀察及訪談方式，發現臨床人員因無適合工具，在與病童溝通上費時卻又無法了解病童需求，甚至有50%的病童因需求無法立即滿足，進而產生部分負向行為。目的：透過專案建立適宜的溝通方式改善病童與護理人員的溝通模式，使病童的需求得到滿足並提升護理人員與病童的有效溝通。解決方案：本專案針對重症學齡期病童發展多元化之溝通輔具（溝通圖卡、掌上型溝通板、注音磁板），藉由溝通輔具以及教育訓練來解決溝通費時及提高病童需求被滿足率。結果：重症病童需求被滿足率由50%提升至98%，護理人員了解病童需求的時間由每次15分鐘縮短至4分鐘。結論：此專案有利於臨床護理人員與病童關係的建立以及互動，期望藉由此專案可推廣溝通輔具於臨床，作為重症兒童溝通及減輕因溝通不良所產生的住院壓力之運用。

Background & Problems: Children in the PICU who are treated for illnesses using intubation are often unable to express their needs effectively. This project first used a self-designed survey to record the researcher's observations and interview data. Results indicated that even with clinical staffs trying their best to understand PICU patient needs, 50% of the patients had unmet demands due to inadequate communication. This unmet demand was a source of negative patient behavior.Purpose: This project developed an appropriate communication system to improve communication efficacy between children and clinical staffs in order to meet patient demands and improve PICU patient outcomes.Resolution: Various types of auxiliary school-aged-children-appropriate communication tools such as picture cards, hand-held communication boards, and magnetic spelling board were used. Using these communication tools together with education and training greatly improved communication efficacy and patient needs provision.Results: Percentage of patient needs met increased from 50% to 98% and the average time clinical staffs needed to spend to understand a patient's needs decreased from 15 to 4 minutes per instance.Conclusions: This project improved relationships and interactions between clinical nurses and school-aged children. The developed auxiliary communication tools may be introduced in the PICU based on the results of this project as an effective approach to improving patient-staff communication and reducing patient-perceived hospitalization stress.