運用跨團隊模式提升血液透析患者手部握球運動正確率

Using Interdisciplinary Cooperation to Improve the Rate of Proper Performance of a Hand Exercise Among Hemodialysis Patients With Arteriovenous Fistula Construction

背景血液透析病患新建動靜脈瘻管術後，為了強化其功能，應執行握球運動，但常因肌耐力差及運動強度或方式不當，使肌肉痠痛，而降低執行意願。目的本專案旨在提升患者手部握球運動正確率由55%提升至80%。解決方案經查檢及深入訪談發現原因為：(1)肌肉耐力不足；(2)運動工具未標示阻力強度；(3)運動工具難抓握；(4)缺乏握球運動照護流程；(5)護理人員對於教導病患握球運動方式認知不足。解決方法為：(1)與復健科跨團隊合作，設計50–60% 1RM運動訓練計畫；(2)改良握球工具；(3)制定手部運動照護流程；(4)舉行在職教育；及(5)培育護理指導種子人員。結果手部握球運動整體正確率由55%提升至93%。結論本專案透過復健科跨團隊合作，改善手部握球運動方式及工具，提升正確率，亦可改善臨床動靜脈瘻管照護品質。

Background & Problems: Patients who undergo new arteriovenous fistula (AVF) construction as part of their hemodialysis treatment program are required to perform hand exercises properly in order to maintain AVF function. However, poor performance of these hand exercises currently results in the failure of many patients to preserve AVF function. Purpose: To increase the rate of performing this hand exercise properly from 55% to 80%. Resolution: A comprehensive investigation identified the following five main problems: (a) Insufficient muscular endurance; (b) Resistance was not labeled on the ball; (c) Difficulties with maintaining a grip on the ball during the exercise; (d) Lack of standardized education procedures; and (e) Nurses lack latest knowledge on the hand exercise. The strategies used to improve the situation included: (a) Interdisciplinary team cooperation with physiotherapists to design individualized resistance training regimens; (b) Exercise tool improvement; (c) Standardized AVF care; (d) Continuous education for nursing staffs; and (e) Seed teacher program for hand exercise. Result: The rate of proper hand exercise performance increased from 55% to 93%. Conclusions: This nursing project involved an interdisciplinary team that included physiotherapists in order to successfully improve the rate at which the hand exercise was performed properly. This positive experience may be applied to other hemodialysis departments in the treatment of patients with AVF.