提升安寧病房護理人員徒手淋巴引流執行正確率之改善專案

Enhancing Accuracy of Executing Manual Lymphatic Drainage among Nurses in a Hospice Ward

「淋巴水腫」是末期病人困擾症狀之一，嚴重影響生活品質，徒手淋巴引流可有效緩解，但臨床病人於執行淋巴引流後反應不舒適及滿意度僅2.3分（1—5分），而引發此案動機。透過病人的淋巴水腫不適症狀調查、護理人員執行徒手淋巴引流認知與執行正確性調查發現，護理人員徒手淋巴引流執行技術正確性59.3％，分析原因為：護理人員徒手巴引流認知正確性68.3％、兩年內未再接受相關教育訓練、書面教案不具體缺少圖示導致無法理解、徒手巴引流操作步驟達33項複雜難記及缺乏定期稽核監控制度。經製作多媒體教學檔案、操作指引小卡、舉辦在職教育及制定監控計畫改善策略。結果顯示護理人員徒手巴引流執行正確率提升至96.3％，多元介入策略可有效達預期目標，提升護理人員徒手淋巴引流認知及執行正確率，提升末期病人照護品質。

Lymphedema is one of the bothersome symptoms of terminal patients, which severely affects the quality of life. Manual lymphatic drainage can effectively relieve edema. However, it may not be comfortable and could lead to low satisfaction among patients. Therefore, we conducted a survey to understand symptoms of lymphedema discomfort among patients and evaluate the recognition and accuracy of executing manual lymphatic drainage among nurses. We found that the accuracy of performing manual lymphatic drainage was only 59.3%. The reasons included low recognition of 68.3%, no participation of related educational training in two years, insufficient teaching materials due to lack of illustrative pictures, and difficulty in memorizing the 33-step procedure, and a lack of assessment mechanism. This project included creating a multimedia teaching material and operationalized instructions on flash cards, holding an in-service education program, and establishing a regular assessment plan. The results showed the accuracy of performing manual lymphatic drainage increased to 96.3%. Multiple strategies can effectively enhance the recognition and accuracy of performing manual lymphatic drainage, successfully promoting the quality of life of terminal patients.