跨領域合作提升護理師，血液腫瘤病人每日活動指導完成率

Multi-Disciplinary Cooperation Improves the Completion Rate of Nursing Instructions of Daily Activity for Hematological Patients

2016年單位3位病人跌倒原因與活動無耐力相關，且日常活動護理指導易受忽略，引發專案改善動機。分析單位活動護理指導完成率低的導因為，護理師活動護理指導認知及自信心不足、執行活動護理指導阻力大；病人活動護理指導認知及執行能力不足、疲憊不適；缺乏指導輔助工具。透過跨團隊合作與復健師及教學部門，共同拍攝多媒體影片製作，及繪製成QR code，並置放於護理部中央網站，提升活動指導品質及效能，舉辦由復健師主講活動護理指導之在職教育課程，製作活動護理指導單張，並建立指導規範，綜合以上，活動護理指導完成率可由32.7%提升至73.7%，經持續監測專案改善後1年內，因活動無耐力造成跌倒之發生率可由0.05%下降至0.02%，每月全面查核住院大於5天的病人，活動護理指導完成率可達99.4%。建議善用跨團隊合作及多媒體資源；發展專科性運動處方，提升病人活動護理指導成效。

"In 2016, we observed three cases of fall resulting from a lack of endurance and a neglect of nursing instructions on daily activities. These observations led to this patient care-improvement project. Cause analysis low completion rate of nursing instruction identified relevant factors including insufficient self-confidence in nursing instruction for nursing staffs and patients, resistance from patients in executing the instructions, patients' fatigue, and lack of education-assisting tools. Educational multimedia videos with QR codes, fabricated through cross-team cooperation with physical therapists and the department of education, were provided at the website of the department of nursing. Continuous education courses lectured by rehabilitation specialists were held to improve the quality and efficiency of activity instruction. Nursing instruction notes and procedures were established. Through these interventions, the completion rate of activity nursing guidance improved from 32.7% to 73.7%. Within one year after executing this project, the incidence of falls resulting from activity intolerance reduced from 0.05% to 0.02%. Monthly surveillance with patients hospitalized for 5 days or longer showed the completion rate of nursing instructions as 99.4%. The result suggests that applications of cross-team cooperation with adapting multimedia resources and developing specific sports prescriptions could efficiently improve the effectiveness of nursing instructions."