運用創造思考教學提升二年期護理師腹部引流管照護完整率

Using Creative Thinking Teaching to Improve Abdominal Drainage Tube Care Integrity Among Two-Year Post Graduate Nurses (PGNs)

背景：腹部引流管是治療疾病及維護病人生命的重要設備，若發生滑脫，可能產生合併症、延長住院時間及增加醫療成本。統計2019年外傷科病房腹部引流管滑脫件數共11件，較2018年上升7件，其中發生於二年期護理師佔9件。目的：提升二年期護理師執行腹部引流管照護完整率達94%。解決方案：建立外傷科病房腹部引流管照護標準模組；運用「引流管模型」及腹部引流管照護多媒體教材進行教學，增加技術熟練度；調整專科管路照護課程時間並運用創造思考教學模式（creative thinking teaching model）進行教學活動；設計腹部引流管直接觀察操作型技術評量表（direct observation of procedural skills），評值護理師技術；建立引流管照護技能稽核機制。結果：二年期護理師腹部引流管照護完整率提升至98.1%、腹部引流管照護認知提升至100%、病人腹部引流管滑脫率0%。結論：本專案成效良好，解決對策平行推展其他外科系病房，運用創造思考教學模式進行教學活動護理師學習回饋佳，因此將此教學模式納入病房在職教育標準；下階段計畫為將腹部引流管直接觀察操作型技術評量表進行資訊化並與二年期護理師電子學習護照結合，讓學習歷程更加完整。

Background & Problems: The abdominal drainage tube is an important device used in disease treatment and life maintenance. Drainage tube slippage leads to complications that increase both length of stay and costs of care. Four and seven cases of drainage tube slippage were reported, respectively, in 2018 and 2019 in our trauma wards. Among these, 9 cases were under the care of nurses in their post graduate year (PGY) training program. Purpose: To increase to 94% the abdominal drainage tube care-completeness rate of nurses in the PGY program. Methods: Methods used included: establishing a standardized care module for abdominal drainage tube in the trauma wards, using the ＂drainage tube model＂ and multimedia teaching material in education to enhance skill proficiency, flexibly adjusting education schedules, using a creative-thinking teaching model in education, employing direct observation to evaluate PGY nurses' abdominal drainage tube skills; and establishing a drainage tube skill proficiency audit mechanism. Results: After the intervention, the rate of care completeness for the abdominal drainage tube rose to 98.1%, participant awareness rose to 100%, and the rate of abdominal drainage tube slippage reduced to 0%. Conclusions: This project achieved good outcomes that may be expanded horizontally to other surgical wards. The use of the creative-thinking teaching model in training activities received good feedback from the nurse participants and will be incorporated into in-service education standards along with the computerized direct observation of procedural skills in the PGY e-learning passport to strengthen the completeness of learning processes.