提升血液透析室護理師執行小兒透析臨床能力改善專案

A Project to Enhance Nurses’ Clinical Competence in Pediatric Hemodialysis

本院小兒透析病人數少，且小兒透析與成人最大不同除了體表面積較小、血管細小外，併發症與透析器及體外循環量有關，其實務操作與成人有很大差異。知識不足、技術不熟練，會危及病童生命安全，故本專案目的在提升護理師執行小兒透析臨床能力。分析護理師執行小兒透析臨床能力不佳之主要原因包括實務操作及併發症知識不足、管路操作不正確、護理技術標準訂定未詳盡、未制訂評核表及缺乏定期稽核等。藉由辦理在職教育、執行標準技術流程及定期稽核、製作操作技術多媒體光碟、執行種子人員定期更新技術等措施改善，結果知識正確率由20.5％提升至100％；技術執行正確率由37.8％提升至100％；對執行小兒透析之態度由3.0分提升至4.1分。經介入措施有效提升護理師小兒透析臨床能力，提供病人安全的醫療環境。

Background: Pediatric hemodialysis cases were rare at the hospital. Pediatric patients not only have a smaller body surface area and much thinner veins than adults, their complications associated with dialyzers and the volume of external blood circulation also mean there are significant differences between the practice of pediatric and adult hemodialysis. The lack of related knowledge and skills therefore pose a risk for young patients.
Purpose: The aim of this project was to enhance the nursing staff’s clinical competence in pediatric hemodialysis.
Resolution: During this project, we found that the causes included (1) a lack of clinical practice and of knowledge on complications, (2) the need for correct tubing operation, (3) inadequacies in the nursing standard process, and (4) a lack of evaluation and monitoring forms. Several interventions were taken in this project, including the establishment of standard procedures and related audits, producing a CD-ROM on clinical practice, and regular continued education for principal instructors.
Results: The results showed that the accuracy of professional knowledge was improved from 20.5% to 100%; clinical practice proficiency was increased from 37.7% to 100%; and the attitude score was increased from 3.0 to 4.1.
Conclusion: The clinical competence of pediatric hemodialysis nurses was enhanced, providing patients with better care.