提升腫瘤病人化學治療護理指導成效之專案

Improving the Effectiveness of Nurses’ Instructions to Patients after Chemotherapy

有效益的護理指導對腫瘤病人化學治療後的照護相當重要，可減輕其不必要焦慮並提升自我照顧能力，本文旨在提升化療護理指導成效。護理指導成效不佳之主要原因為：未安排護理指導相關在職教育、未設立標準作業及缺乏稽核制度。護理師未掌握指導時機、謹慎度及正確知識不足。指導工具缺乏多元性及單張歸類標示不清。病人學習動機不強且身體疲累。家屬太常更換且學習動機弱。對策採制定標準作業流程、舉辦在職教育、定期監測成效、多樣化輔助教學工具、單張櫃歸類並清楚標示。改善後提升護理指導成效( 執行率由45.0% 至91.1%、完整率由19.3%至84.1%、病人對護理指導平均滿意度由62 至84 分)，顯示方案達成專案目標且有助於提升護理指導成效，建議作為日後化療病人護理指導之參考依據。

Effective post-chemotherapy instructions from nurses can reduce patients’ anxiety and improve their self-care. Our goal was to improve the effectiveness of nurses’ instructions to patients after chemotherapy. The effectiveness of instructions provided by our oncology nurses was unacceptably low for many reasons: unorganized nursing instruction-related education, the lack of standard procedures for providing the instructions and of an auditing system to evaluate them, the nurses’ lack awareness of the proper timing for their instructions and their inaccurate knowledge, a lack of tools for supplementary health education, unclear labeling on the instruction leaflets, patient physical fatigue, low patient motivation to learn, alternating family caregivers, and low family-member motivation to learn. These findings led to a project aimed at improvements that included developing standards for nurses’ instructions to patients after chemotherapy, arranging continuing education for nurses to increase their knowledge of chemotherapy, regular monitoring of the effectiveness of nurses’ instructions, designing a set of varieties of supplementary health education, and clearly classifying and marking nursing instruction leaflets. After the program, the effectiveness of nurses’ instructions improved: the performance rate of nurses’ instructions to patients increased from 45.0% to 91.1%, the completion rate of the instructions increased from 19.3% to 84.1 %, and the mean overall patient satisfaction score with the instructions increased from 62/100 to 84/100. This project achieved its goal of improving the effectiveness of nurses’ instructions. We therefore recommend it as a reference for teaching nurses how to give instructions to post-chemotherapy patients.