運用動機模式提升護理師執行呼吸器噴霧治療流程正確率

Using the Model of Motivation to Improve the Accuracy of Nurses Conducting Aerosol Therapy in Mechanically Ventilated Patients

背景：呼吸器噴霧治療若操作不當，會降低療效及增加感染風險。因經調查發現護理師操作流程正確率僅55.9%，引發改善動機。經分析，要因包括護理師學習經驗及教育訓練資源不足、缺乏標準技術指引及評核機制；以及吸藥輔助器組合方式繁複不熟悉、醫材配置分散、沒有正確圖示等。目的：呼吸器噴霧治療執行流程正確率提升至90%以上。解決方案：運用促進學習動機、提升學習成效的動機模式概念設計多樣教材，及促進學習體驗，並增加技術指引及未來評核機制；運用實證簡化醫材組裝方式及醫材種類，並優化庫房環境、增設參考圖示以改善設備環境。結果：護理師執行流程正確率由55.9%提升至95.0%。結論：本專案運用動機模式融入教學方案設計，並活用課室及多媒體互動等多種教材，獲得高教學滿意度和學習成效，再輔以硬體設備簡化、環境改善，以提升現階段護理師技術操作的正確率；另加入標準技術指引、線上教學影片、評核機制等工具，使執行流程能標準化並推廣至其他單位。

Background & Problems: Aerosol therapy is increasingly used in pulmonary critical care and in patients with respiratory disease. However, improper application of the aerosol delivery device will decrease the therapeutic effect as well as increase the incidence of pulmonary infection. An initial assessment conducted in our intensive care unit found an accuracy rate for nursing staff aerosol-therapy execution of only 55.9%. Possible reasons identified for this low rate included lack of learning experience and resources, lack of related standard operating procedures, lack of related performance assessments, complicated/unfamiliar device assembly procedure, diffuse storage of device components, and a lack of illustrations. Purpose: This project was developed to increase the accuracy rate of performing aerosol therapy to over 90% in our intensive care unit. Methods: We designed diverse learning materials using the model of motivation, developed an evaluation system, simplified the assembly of components based on evidence-based research, improved the storage situation, and added reference illustrations. Result: The accuracy rate in aerosol therapy execution for our nursing staff increased from 55.9% to 95.0% after the intervention. Conclusions: This project used the model of motivation to develop the teaching materials. By using diverse teaching methods, including both in-person classes and online interactive quizzes, we realized high learning satisfaction and efficacy. Along with simplifying equipment handling, improving the working environment, enhancing nurses' aerosol therapy techniques, establishing standard operating procedure guidelines, and adding an evaluation system, we standardized the entire procedure for potential promotion to other intensive care units.