提升血液透析病人規律運動之改善專案

A Nursing Project to Promote Regular Exercise for Hemodialysis Patients

規律運動能改善血液透析病人的身心健康，然而，血液透析病人因疾病本身與長期接受治療的因素，包含面臨疲勞、身體不適、活動無耐力、甚至害怕受傷或病情加重、缺乏動機等，因此從事規律運動似乎較一般人困難。本院調查血液透析病人僅15.7%從事規律運動，故引發本專案改善動機。專案小組根據現況分析主要問題為：1.護理師對血液透析病人從事運動的認知不足、2.缺乏合適的護理指導工具、3.缺乏血液透析患者執行運動之標準化常規、4.病人及照顧者對執行運動的認知不足、5.運動設備不足。經團隊擬定解決對策包含：舉辦教育訓練、製作血液透析病人運動訓練護理指導工具、制定運動訓練照護流程、舉辦團體衛教及購置床上固定式腳踏車。專案改善後護理師對血液透析病人運動訓練認知正確率由64.0%提升至87.2%、護理指導執行率由0%提升至90.2%；血液透析病人規律運動比率由15.7%提升至47.1%，顯示本專案能有效提升病人的規律運動。

Regular exercise has been shown to have numerous benefits for hemodialysis patients, improving both their physical and mental health. However, promoting regular exercise among this population is more challenging compared to the general population. Hemodialysis patients often experience fatigue, physical discomfort, activity intolerance, fear of injury, and lack of motivation due to their condition and long-term treatment. A survey conducted at our hospital revealed that only 15.7% of hemodialysis patients were engaging in regular exercise, which served as a catalyst for this project. The primary objective of this project was to increase the rate of regular exercise completion among hemodialysis patients. Our project team identified several significant problems that needed to be addressed, including (1) inadequate knowledge among nurses regarding promoting exercise for hemodialysis patients, (2) a lack of appropriate nursing guidance tools, (3) the absence of a standardized procedure for hemodialysis patients to perform exercises, (4) insufficient awareness among patients and caregivers about the importance of exercise, and (5) a lack of exercise equipment. To tackle these challenges, we developed a comprehensive set of strategies. These strategies included conducting education courses on exercises for hemodialysis patients, creating an exercise training nursing guide tailored to their needs, organizing group in-service educational training, revising and implementing standard procedures for exercise promotion among hemodialysis patients, and procuring fixed-bed ergometers to provide intradialytic exercise training. After the successful implementation of this project, the accuracy of awareness related to exercise training for hemodialysis patients among nursing staff significantly increased from 64.0% to 87.2%. The execution rate of nursing education for exercise training increased from 0% to an impressive 90.2%, and the rate of regular exercise among patients with hemodialysis remarkably increased from 15.7% to 47.1%. Overall, this project was highly successful in encouraging hemodialysis patients to engage in regular exercise.