提升骨科護理師對血友病行膝關節置換術照護能力與正確率

Improving the Competence and Accuracy of Orthopedic Nurses to Care for Hemophilia Knee Arthroplasty Surgery

本專案主要在提升骨科護理人員對於血友病患者行人工膝關節術後照護能力與正確率。因血友病病人屬手術高危險族群，會面臨手術出血風險、感染及併發症等問題，經過去手術個案常抱怨骨科護理師對於血友病相關照護問題生澀且不熟悉，感覺專業度不足，故特成立專案小組探討相關問題。經團隊運用決策矩陣提出解決辦法：1.舉辦在職專科教育訓練、2.建置血友病行人工膝關節置換照護紀錄表、3.製作凝血因子稀釋及注射步驟圖卡、4.製作傷口拍照方法圖卡。實施後，於認知方面由57.7%提升為89.9%，照護技能正確率由56.8%提升至100%，照護信心指數由5.1分提升為8.6分，照護焦慮程度由7.7分降至3.9分。由此發現建置血友病患者行人工膝關節術照護模式能有效改善護理人員照護能力，並降低照護焦慮程度，進而提升醫療照護品質。

This project aims to enhance the clinical competence and accuracy of nursing care for hemophilia patients undergoing total knee arthroplasty ( TKA ). The improvement program included: 1 ) In-service education and training; 2 ) Development of a care sheet for hemophilia patients with TKA; 3 ) Creation of flash cards detailing the steps for coagulation factor dilution and injection; and 4 ) Standardization of the protocol for wound photo documentation. Following the implementation of the program, cognition increased from 57.7% to 89.9%, the accuracy and completeness of care improved from 56.8% to 100%, and the confidence index increased from 5.1 to 8.6. Additionally, the mean anxiety levels among nursing staff decreased from 7.7 to 3.9. In summary, this program effectively enhanced nursing competence and reduced anxiety in the care of hemophilia patients undergoing TKA.