改善護理師處理血液腫瘤病人敗血性休克能力知多元教學策略

A Multi-Strategic Education Project for Improving Nurses Competence on Septic Shock Management in Hematology Patients

免疫低下的血液腫瘤病人發生敗血性休克後，死亡風險高，如果無法即早發現臨床症狀，以進行有效溝通處置，敗血性休克會導致非預期急救失敗的案例，此專案期望能提升護理師在敗血性休克緊急應變處理能力。導因為護理師對敗血性休克緊急應變處理經驗、認知、技能及自信心不足；教育訓練不足、缺乏情境演練、未善用教學資源；團隊溝通及異常警訊通報不足；缺乏標準作業處理流程；PGY（post-graduate year）醫生經驗及處理能力不足。運用多元教學策略，包括跨國團隊討論並建立緊急應變標準作業流程，善用翻轉教室及情境模擬教學策略、創意式組合口訣，完成團隊情境模擬教育訓練。透過這些措施，敗血性休克認知由31.5％提升達98.6％、緊急應變處理技能由46.6％提升達96.％，且未再發生非預期性急救案例。

The risk of death after septic shock in immunocompromised patients with hematological cancers is high. If clinical symptoms cannot be detected early for efficient communication and management, the septic shock would result in an unexpected resuscitation failure. In this study, we aimed at enhancing nurse staff's competences in the early management of septic shock. The poor performance in dealing with septic shock might result from inadequate management experience, knowledge, skills, self-confidence, insufficient staff education, lack of situational exercises, limited use of training resources, inefficient team communication and warning notification system, a lack of standard operating procedure, suboptimal experience and capabilities of PGY (post-graduate year) physicians. Multiple strategies, including cross-disciplinary discussions for establishing standard procedures of rapid responses, making use of educational resources such as flip classes and simulations, using creative mnemonic phrases, and simulative group training with informative system integration. With these interventions, the knowledge about septic shock improved from 31.5% to 98.6%, the skills of urgent management increased from 46.6% to 96.8%, and no more unexpected resuscitation case occurred.