提昇乳癌病人術後執行運動正確率之改善方案

A Project to Promote Correct Rehabilitation for Post-operative Breast Cancer Patients

乳癌病人術後易有手臂感覺障礙及肩部無法伸直等問題，復健運動可有效改善症狀。本專案旨在改善乳癌病人術後執行復健運動的正確率，專案期間2009年11月1日至2010年4月30日，現況問題：護理人員執行復健運動指導之正確率僅51.1%、病人執行復健運動正確率37.1%及術後患肢不適感覺強度為4.1分，主因：復健運動作業規範不完整、未舉辦在職教育及未列入品質稽核。擬定解決方案為修訂標準作業規範、製作乳癌病人術後衛教本、淋巴圖卡、制定品質監控計劃，舉辦在職教育及病友會。結果護理人員執行復健運動指導正確率提昇為91.8%、病人執行復健運動正確率提昇為88.1%、降低病人患肢不適感覺強度至2.5分以下。

Rehabilitative exercises are known to improve arm paresthesia and restriction in arm abduction that are common in patients after surgery for breast cancer. This study aimed at investigating the quality of rehabilitative exercises that patients underwent after breast cancer surgery between November 1, 2009 and April 30, 2010. The results showed that only 51.1% of nursing staff were able to give correct guidance for rehabilitative exercises and only 37.1% of patients exercised correctly. The mean discomfort level of affected arm reported by the patients was 4.1 on a scale of 10. The causes were attributable to leak of a complete standard operation procedure, insufficient staff training, and failure to include this item in quality assurance program. The strategies for improvement included revising the standard operation procedure, publishing brochures with information on appropriate rehabilitative exercises after breast surgery and correct procedure of lymphatic massage, establishing a quality-monitoring system, organizing in-service training courses for nurses and group education for patients. After implementation of these strategies, 91.8% of nursing staff were able to in provide accurate guidance on rehabilitative exercises for patients after breast surgery, 88.1% of patients were able to exercise correctly, and the discomfort on afforded arm decreased to a level lower than 2.5.