運用多元教學提升護理人員執行CVVH照護能力

Enhancing Nursing Staff Competency in CVVH Care Through Diverse Teaching

目的：連續性靜脈血液濾過術（Continuous Venovenous Hemofiltration, CVVH）為治療重症燒傷病人衍生急性腎損傷與血液動力學不穩定的重要處置。本專案旨在提升護理人員執行CVVH照護能力，提升醫療照護品質。方法：透過訪談、照護認知問卷調查及臨床照護技能查核，包括使用頻率低、知能與技能不足、在職教育缺乏實際操作、缺乏定期稽核、標準技術文字艱澀。改善策略採用多元教學，創意教學，3D列印教具，給予即時操作回饋，製作CVVH操作教學影片及操作手冊，提供即時查閱，建立定期稽核制度，確保CVVH照護品質。結果：專案介入後，「CVVH照護認知問卷」正確率由40.9％提升至96.4％；「CVVH臨床照護技能調查」正確率由23.6％提升至100％。此外，臨床執行CVVH裝機作業時間，由30分鐘以上縮短至17.5±1.8分鐘，並可獨立完成裝機作業，顯示臨床執行效率顯著提升。結論：本專案運用多元教材及3D列印教具結合臨床實務教學，不僅有效提升燙傷護理人員對CVVH操作的專業知識與技能，還增強了CVVH緊急應變處理能力。建議未來針對少見重症照護技能，可結合跨單位協同教學、分段式多元教學策略與定期技能稽核，持續維持專業照護能力。

Purposes: Continuous veno-venous hemofiltration (CVVH) is an important treatment for managing acute kidney injury and hemodynamic instability in patients with severe burns. The aim of this project is to enhance nurses’competency in performing CVVH care and to improve the quality of medical services. Methods: Through interviews, a care-related knowledge questionnaire, and clinical skill assessments, several issues were identified, including infrequent use of CVVH, insufficient knowledge and skills, lack of hands-on practice in in-service education, absence of regular audits, and overly complex technical terminology. Improvement strategies include adopting diversified and creative teaching methods, using 3D-printed teaching aids, providing real-time feedback during practice, producing CVVH instructional videos and operation manuals for immediate reference, and establishing a regular audit system to ensure the quality of CVVH care. Results: After the project intervention, the accuracy rate of the CVVH Care Knowledge Questionnaire increased from 40.9% to 96.4%, and the accuracy rate of the CVVH Clinical Care Skills Assessment improved from 23.6% to 100%. In addition, the time required to perform CVVH setup in clinical practice was reduced from more than 30 minutes to 17.5±1.8 minutes, and staff were able to complete the setup independently, demonstrating a significant improvement in clinical performance efficiency. Conclusions: This project utilized diverse teaching materials and 3D-printed instructional models integrated with clinical practice training. It not only effectively enhanced burn care nurses’professional knowledge and skills in operating CVVH, but also strengthened their ability to respond to CVVH-related emergencies. It is recommended that, for infrequently encountered critical-care skills in the future, cross-unit collaborative teaching, segmented and diversified instructional strategies, and regular skill audits be incorporated to continuously maintain professional care competence.