高齡心臟病患於跌倒評估與預防之初探

Fall risk assessment and prevention in elderly with heart-related diseases

背景：跌倒是醫療機構中高齡病患普遍存在的問題，可能造成身體機能損傷，甚至死亡，使醫療服務負荷技成本增加。目的：本研究目的在了解高齡心臟病是、住院期間跌倒原因，未來可依據此研究結果進一步發展出預防之介入措施。方法：採質＇I哇研究設計，以立意取樣訪談兩位心臟科高齡（65歲及70歲）病患住院期間有跌倒經驗者，藉由文獻回顧及專家諮詢方式發展出的半結構式訪談大綱為研究工具，以一對一訪談方 式進行資料收集，收集之資料使用內容分析法進行分析。結果：本研究將所收集之資料以內容分析法，分析受訪者之內在觀點，萃取出三大面向，分別為：（一）身體狀況之自覺感受：對自己身體變化的各種感覺及想法，並了解自我照顧的能力﹔（二）跌倒事件反思：回顧事件發生當下情境，並分析出可能導致跌倒的原因﹔（三）醫療機構病人安全需求：以使用者角度，審視醫院軟體及硬體環境是否達到個案自我預防跌倒之基本需求。結論：本研究結果發現導致高齡心臟病患跌倒發生的生因為病患自覺身體狀況良好尚不需他人協助，但研究結果亦指出不適當的輔具、照護者的疏忽及醫療硬體設備不足等均可能引起跌倒發生，而因護理人力配置不足無法即時有效提供病患合適的衛教， 使病患因無法適當瞭解防範跌倒的內容而導致跌倒意外事件發生，亦為原因之一，除應重視病患對自我健康狀態的自覺，及醫療環境外，更應關注護病比失衡及護理工作負荷過童，對跌倒意外事件造成的嚴重影響。

Background: Falls are the most common issue for elderly in medical institutions and can cause injury or death﹔ this increases the burden and cost of medical services.Objective: This study investigated the reasons hospitalized older cardiology patients fall. The results of this study can be used to develop preventive intervention measures in the fu仙re. Methods: This qualitative study used purposive sampling to recruit two elderly cardiology patients who had fallen during their hospital stay. A semi-structured interview outline was developed based on literature review and expert consultations. Data was collected through individual face-to-face interviews and then analyzed using content analysis.Results: The participants in this study were males aged 65 and 70 years. The interviews with the participants focused on falls and their prevention﹔ the results were compressed into the following three dimensions: 1. Self-perception of health: The patient's perception and thoughts about changes in their health and their under­standing of their ability for selιcare. 2. Review on the fall incident process: The patient’s recall of the fall and analysis of the potential causes. 3. Hospital patient safety: The patient’s examina­tion from the user’s perspective of whether the hospital software and hardware met the basic requirements for fall prevention. Conclusion: The above findings on the main reasons of fall in elderly patients having heart disease provide an important reference for medical term is that patients misunderstood that they have good physical condition and do not need assistance. The findings also demonstrated that inadequate assistant devices, caregiver careless and inappropriate equipment in institutions can cause patient falls. In additions, insufficient nursing staffing might leads to lack of time to educate patients about fall prevent which is one of the reason of falls. Therefore, it should gather the attention to the shortage of nursing staffing.