提升家庭及外籍照顧者對於重度失智者管灌營養之正確認知率

Improving the Knowledge of Family and Foreign Caregiver Regarding Tube Feeding for Persons with Advanced Dementia

重度失智症（persons with advanced dementia, PWAD）病人因為功能退化導致吞嚥困難，需要照顧者採取管灌餵食才能維持身體所需營養，若照顧者缺乏正確之管灌營養照顧知識，將產生多種併發症，甚至加速病情之惡化，故居家營養照護為重要且不容忽視的議題。營養的充足是病人居家生活品質的重要指標之一，因此提升營養照顧技巧為外籍照顧者最首要且迫切的需求。本文專案旨在提升家庭及外籍照顧者對於重度失智者管灌營養認知。經現況分析發現照顧者對於管灌營養正確認知率僅64％，原因為外籍照顧者語言、文字不熟悉、缺乏管灌營養評估及記錄工具、缺乏一致性的衛教。本專案由2017年10月25日至2018年01月08日訂定「外語指導的營養照顧日誌」、設計「每日管灌所需照護指引」、創作「營養轉盤指導工具」後，照顧者執行管灌營養之正確認知率從64％提升至93％，達本專案設定目標。建議未來將此管灌專案及衛教工具轉為網路資源，以提升衛教的即時性及完整性，滿足照顧重度失智者家庭的需求，減輕他們沉重的負擔，提高照顧重度失智者家庭之居家照顧品質。

Patients with advanced dementia (PWAD) have dysphagia due to functional deterioration. It is necessary for the caregiver to take tube feeding to maintain required nutrition of the body. If the caregiver lacks the correct tube nutrition nursing knowledge, it will lead to a variety of problems and even accelerate the deterioration of the disease. In short, home nutrition care is an important issue that cannot be ignored. Adequate nutrition is one of the important indicators of the quality of life of patients at home. The most pressing need was to enhance the knowledge regarding tube feeding of these family and foreign caregiver. Therefore, the purpose of this project was to enhance nutritional knowledge of tube feeding for PWAD. In current situation, the foreign home helpers only had 64% of correct understanding of tube feeding for PWAD. The reasons for the poor understanding were language barriers, lack of recording and assessment tool for tube feeding, and lack of consistency in health education provided by home care nurses. This project provides the ''nutrition care diary in foreign languages'', ''daily care guidelines for tube feeding'', and the ''daily calories liquid food conversion table''. From October 25, 2017 to January 08, 2018, the rate of correct answers of tube feeding increased from 64% to 93% after the intervention. Based on this project, it is recommended that these developed tube feeding guidelines can be used as network resources to enhance effects of the health education in a timely manner, meet the needs of the PWAD, reduce the burden of the caregiver, and improve the quality of home care.