運用多元策略提升急性腦中風病人早期復健運動之執行率

Applying Multiple Strategies to Increase the Rate of Early Rehabilitation Exercise Adoption in Patients With Acute Stroke

背景：早期復健運動雖能減緩急性腦中風病人的失能程度，然而臨床上多數腦中風病人執行早期復健運動的比率卻偏低，以本機構為例，醫療團隊在2013年發展一套腦中風病人早期復健運動照護計畫，惟追蹤執行率低，經調查發現病人及照顧者對早期復健運動認知不足、單位缺乏適當的復健器材與輔具、缺乏合適的護理指導工具及交接班紀錄、新進護理師對早期復健運動認知不足等，故成立專案期望提升病人早期復健執行率，減緩其失能程度。目的：專案目的為提升新進護理師對早期復健運動照護認知的正確率及護理人員對早期復健運動護理指導的完整率，進而提升急性腦中風病人早期復健運動執行率。解決方案　本專案經原因分析後介入多元策略之改善方案包含：（1）使用圖文並茂的海報、護理指導單張、影片；（2）舉辦團體衛教；（3）研發移位保護帶；（4）增設虛擬實境復健運動設施以結合虛擬實境訓練；（5）修改及實施急性腦中風病人早期復健運動照護作業流程；（6）改善護理交班機制；及（7）舉辦早期復健運動照護在職教育。結果：新進護理師對早期復健運動照護認知的正確率由31.3％提升至80％；早期復健運動護理指導完整率由53.6％提升至98.0％；急性腦中風病人早期復健運動執行率由37.1％提升至82.2％。結論：本專案小組藉由修訂照護流程，提供創意復健輔具與照護措施，並結合虛擬實境訓練於早期復健運動治療中，引發腦中風病人復健的興趣與自信，有效提升早期復健運動執行率，期能改善病人的生活品質。

Background & Problems: Early rehabilitation exercise has been shown to reduce the onset of disability in patients following acute stroke. However, the clinical execution rate of early rehabilitation exercise for those patients remains low. Our medical team developed an early rehabilitation care plan for patients with acute stroke in 2013, at which time the execution rate of early rehabilitation exercise for these patients in our hospital was only 37.1%. The survey found that patients and caregivers had insufficient awareness of early rehabilitation exercise; hospital staffs lacked appropriate assistive devices, rehabilitation equipment, nursing guidance tools, and handover records; and new nursing staffs were insufficiently aware of the importance of early rehabilitation exercise. This care plan was developed to improve the execution rate of early rehabilitation exercise in patients with acute stroke to slow the progression of their disability. Purpose: The project was designed to improve the knowledge of new nursing staffs regarding early rehabilitation care and the early rehabilitation exercise completion rate of nursing staffs to raise the execution rate of early rehabilitation exercise in patients with acute stroke. Resolution: After completing the cause analysis, multiple strategies were pursued: (1) nursing education sheets with texts, illustrations, video, and posters were used; (2) group in-service educational training was organized; (3) an innovative transfer belt was designed; (4) facilities were set up to deliver virtual-reality (VR) training; (5) standard procedures on early rehabilitation exercise in patients with acute stroke were revised and implemented; (6) nursing handover procedures were revised; and (7) education courses on early rehabilitation exercise for post-stroke patients were developed. Results: The accuracy of knowledge related to early rehabilitation exercise among new nursing staff improved from 31.3% to 80%; the completion rate for nursing education increased from 53.6% to 98%; and the early rehabilitation exercise execution rate increased from 37.1% to 82.8%. Conclusions: This project successfully increased the motivation and confidence of patients in rehabilitation and the rate of exercise program execution, which may be expected to impact positively on patients’ quality of life.