提升護理人員執行口腔癌皮瓣重建術後病患口腔照護之改善專案

Project to improve nursing stuff oral hygiene in flap reconstructed oral cancer patients

口腔癌病人行皮瓣重建手術術後傷口在口內，口內常會屯積血水、血塊、分泌物等，人員若未能提供正確照護，可能引發感染的發生。2013年6月調查護理人員之口腔癌皮瓣重建術後病人口腔護理認知及照護正確率，認知正確率僅達49%，照護正確率僅60.1%。經調查分析主要問題為護理人員缺乏實際回覆示教機會、經驗不足、缺乏口腔照護標準及定期稽核、未舉辦在職教育課程及缺乏口腔照護衛教單張。本專案目的為提升護理人員口腔癌皮瓣重建術後病人口腔護理認知正確率至95%，照護正確率提升至91%以上。改善期間為2013年9月至10月，介入措施包括：(1)舉辦在職教育課程、(2)製定照護標準、(3)製訂監測計畫、(4)資深護理人員不定期床邊示範教學及(5)修定衛教單張輔具工具。結果顯示2013年11月護理人員口腔護理認知正確率提升至100%，照護正確率提升至96.8%。透過舉辦在職教育課程、床邊示範教學、建立口腔癌口腔照護標準及定期稽核，確實提升護理人員之口腔癌皮瓣重建術後病人照護，使其獲得更好的口腔照護品質。

Limitation of mouth opening, surgical wounds, and injuries of the oral mucosa impeded access to oral health care of patients who underwent flap reconstruction of oral cancer. In June 2013, a survey research was undertaken to determine the oral health care knowledge and practices of nurses for those patients just mentioned above and the average correct rate of knowledge was only 49% and the accurate rate of practices was 60.1%. Major problems were lack of response to the teaching demonstration, incorrect nursing technique, lack of experience, no regular checkup, no in-service education program and no health education leaflets. The purpose of this study was to improve the correct rate of the oral health care knowledge to 95% and practices to 91%.The authors: (1) had held relevant education training programs; (2) had established a standardized nursing protocol; (3) formulated monitor audit protocol; (4)had held bedside teaching demonstration; (5) had revised the health education leaflets during the period between September and October 2013.The correct rate of the oral health care knowledge were improved to 100%, and practices rate improved to 96.8% in November 2013. The resolutions proposed by this study could significantly improve nursing stuff the correct rate of oral health care of patients who underwent flap reconstruction of oral cancer.