提升照服員協助長期臥床病人被動關節運動之專案

Increasing Nurse Aide’s implementing of Passive Range of Motion on Bedridden Patients

背景：本院常規調查發現護理人員對照顧服務員（照服員）執行被動關節運動的滿意度遠低於其他照顧事項，分析後導因於照服員認知不足、醫護人員未落實交班、無相關規範、病人與家屬認知不完全正確等。提升照服員的認知有助於其主動執行被動關節運動，當護理人員、病人與家屬對照服員執行被動運動滿意程度提升時，預期可減少護理人員工作負擔、提升照護品質與促進護病溝通。目的：專案主要目的在提升照服員對被動關節運動認知率達90.0%，次要目的為護理人員、病人與家屬對照服員協助被動關節運動的滿意度達75.0%。解決方案：解決措施包括：「設計被動關節運動訓練課程」、「制定被動運動衛教單張使用規範」、「增設電腦交班平台及交班規範」、「擬定照服員考核與獎勵機制」等，用以提升照服員協助臥床病人被動關節運動之成效。結果：專案實施後照服員對被動關節運動認知率達99.3%，專案後一個月的認知率則為100.0%。護理人員及病人與家屬對照服員協助執行被動關節運動的滿意度於專案實施後分別提升至85.3%及88.0%。結論／實務應用：照服員之認知與技能可藉由激勵措施、在職教育與團隊合作等，透過改變其認知並自發性執行被動關節運動，進而持續正確地協助臥床病人執行被動關節運動。專案成果可提供臨床作為病人照護或照服員管理時的參考。

Background: We have found that the nurses’ satisfaction level toward Passive Range of Motion (PROM) by nurse aides is the lowest among all the care components in a routine survey. Four major causes were identified, including “lack of knowledge among nurse aides”, “failure by medical staff to implement proper shift transfer procedures”, “lack of workplace regulations for PROM”, and “negative attitude towards PROM from the patients and families”. By improving recognition of PROM among nurse aides, nurse aides may implement PROM actively in the future. When nurses, patients, and families are satisfied with nurse aides’ implementing of PROM, nurses’ workload may be reduced, and communication between nurses and patients can be improved. Purpose: To improve the recognition rate of nurse aides on PROM to 90.0%. The satisfaction level of nurses, patients and families toward PROM performed by nurse aides could reach 75.0%. Methods: Interventions applied to promote the satisfaction of bedridden patients toward PROM with nurse aides included (a) designing a PROM in-service education program, (b) establishing the regulation of nursing instruction for PROM; (c) providing additional computer platforms, and (d) formulating the evaluation and award system for nursing aides. Results: After the project, the recognition rate of nurse aides on PROM was up to 99.3%, and 100.0% at one month after the project. Satisfaction of nurses, patients and families toward PROM performed by nurse aides were also up to 85.3% and 88.0%. Conclusions/Implications for Practice: The recognition and skills of nurse aides could be improved by conducting the incentive intervention, in-service education, and teamwork. After this project, the nurse aides tended to have stronger intention to implement PROM, and consistently used correct methods to carry out PROM for bedridden patients. The result of this project can provide as a clinical reference for patient care or management of nurse aides.