提升初診斷食道癌病人護理指導之完整率

Improve the Completion Rate of Nursing Guidance for Patients with Newly Diagnosed Esophageal Cancer

背景：初診斷食道癌病人，因生理上遭受進食功能與營養缺失，其角色及情緒功能受影響易出現憂鬱或焦慮，而導致整體生活品質下降。在診斷初期，病人有高度照護資訊的需求，但對於短時間的大量信息常造成吸收負荷。連貫完整的護理指導可促進病人對護理指導之理解程度，進而提升自我照顧能力與生活品質。本單位初診斷食道癌病人陸續有檢查或手術延遲、食物哽塞或進食管路阻塞情形， 於2020年3月2日至3月20日，統計單位對其護理指導完整率僅62.5%，影響照護品質，故引發專案動機

目的：提升護理人員對初診斷食道癌病人護理指導完整率達97.5%。

解決方案：分析原因為護理人員之疾病認知不足、衛教解說耗時、無追蹤機制致重複指導。病人部份包括訊息眾多龐雜影響衛教效率、家屬輪替致指導中斷與不完整。此外尚包括教育資源未符合指導需求、來源與資訊未統合、缺乏追蹤機制等。透過舉辦在職教育、製作衛教卡通圖及工作車桌曆、錄製衛教影片並製作QR Code連結觀看、發放照護手冊及簡易化放療照護包、設計衛教進度檢核表與查核表等策略提升完整率。

結果：透過多元護理指導工具及衛教資源整合可提升連貫完整的護理指導。除了增進病人疾病認知及自我照護能力外，亦使醫療滿意度提升，並促進照護品質。

Background:Patients with newly diagnosed esophageal cancer often suffer from depression and anxiety due to lim­ited oral intake and malnutrition, which affects their physical and emotional function, resulting in a decline in their quality of life. Patients have a high demand for self-care information in the early stages of diagnosis. However, getting large amounts of information in a short time often creates tremendous pressure for the patients. Coherent and compre­hensive nursing guidance can increase the understanding of nursing guidance which further improvs patients’ self-care ability. Delayed examination or surgery, choking, or obstruction of the feeding route occur frequently on patients with esophageal cancer initially diagnosed in our unit. A team was established to improve the low nursing guidance com­pletion rate (62.5%).

Purpose: To improve the completion rate of nursing guidance for newly diagnosed esophageal cancer patients from 62.5% to 97.5%.

Strategic procedure: Inadequate nursing knowledge, insufficient continuity of health education, and a lack of after­ward follow-ups in delivering information are identified as main obstacles for medical providers. As for patients, main obstacles include massive information and interrupted or incomplete instruction due to family rotation. In addition, the inconsistent resources and content of the supplementary teaching materials needed to be carefully complied to meet the needs and a health education tracking system needed to be set up as well. As a result, specific strategies were developed to successfully decrease the rate of feeding route obstruction. The strategic procedures included consolidat­ing in-service education, remodeling teaching materials, creating a useful pictorial calendar and work cards, making instructor videos, creating QR code links for teaching materials, and designing standardized education protocols and checklists.

Outcomes Evaluation: The completion rate of nursing guidance increased to 98.2%.

Conclusions: Coherent and comprehensive nursing guidance was created by integrating multiple nursing guidance tools and health education materials. In addition to improving patients’ disease awareness and self-care ability, the im­plementation of the guideline also improves medical satisfaction and the quality of care.