建立使用呼吸器重症病人之臨床營養護理指引

Establishing Clinical Nutritional Nursing Guidelines for Ventilated Patients

病人之營養狀況與呼吸器脫離有密切關係，亟需使用呼吸器病人之臨床營養護理指引，故本研究旨在藉由實證模式建立使用呼吸器病人之臨床營養護理指引。採用實證護理研究方法，研究第一階段於8個資料庫、4個網站執行系統性文獻搜尋2001-2013年之相關文獻，依評析標準共納入11篇文獻回顧，初步建立45項臨床護理指引草案。第二階段進行專家焦點團體會議，邀請10位具臨床營養及護理經驗之專家，參照其建議將「使用呼吸器重症病人之臨床營養護理指引」修改為34項。第三階段以問卷調查10位專家及200位護理人員，評估適用性，確認34項指引包含營養護理評估6項、營養護理措施18項、營養護理評值5項及合併症護理5項，其中建議等級Grade A有33項及Grade B則有1項。研究結果建議呼吸器重症病人應於進入加護病房24小時內完成營養評估，並應從各種不同角度監測病人營養狀況，以早期讓使用呼吸器重症病人達到其營養需求，協助病人早日脫離呼吸器，減輕痛苦，恢復健康。

Successfully weaning patients from ventilators is strongly related to the nutritional status of patients. However, nutritional care guidelines for ventilated patients are not well established in Taiwan. The aim of this study was to develop clinical nutritional care guidelines according to evidence-based medicine. There were three stages in this study. At the first stage, we conducted a systematic review of 8 databases and 4 websites to search the relevant literature for clinical guidelines reported from 2001 to 2013. Eleven studies met our inclusion criteria and were used to draft clinical nutritional care guidelines for ventilated patients; the draft featured 45 items. At the second stage, we held focus group meetings after inviting 10 experts with substantial nursing experience in respiratory care and nutritionists to modify the drafted guidelines. At the third stage, we conducted a questionnaire survey to evaluate the feasibility of the clinical nursing care guidelines. The items were reduced to 34; 6 were related to nutritional nursing assessment, 18 were related to intervention, 5 were related to nursing evaluation, and 5 were related to care in the event of complications. The items were scored, and 33 were Grade A and 1 was Grade B. The results suggested that nutritional assessment capability and sensitivity of nurses can be improved by implementing in-service education. Strengthening skills to implement nutritional care measures can support the weaning of patients from ventilator and can enhance the quality of care.