腹部重大手術後初期腸道營養照護改善專案

A Project to Improve Initial Gastrointestinal Dietary Management and Nursing Care after Major Abdominal Surgery

腸道是人體中消化及吸收營養的最主要場所，當患者施行重大腹部手術後，需要大於或等於5天的禁食時間，才能逐漸地讓腸道功能恢復，而術後營養攝取過程，是病患能否早日恢復健康的關鍵；護理人員此時扮演指導者、陪伴者的重要角色。單位人員對重大腹部手術後，初期腸道營養的患者照護能力不足，故引發執行改善專案的動機，希望藉由本專案的改善提昇重大腹部手術初期腸道營養的照護。2007年3月1日至2007年3月31日，對施行重大腹部手術的患者做護理照護滿意度調查，結果為3.2分〈滿分5分〉，且護理人員初期腸道營養衛教一致性僅38%。經由要因分析確立問題為：1.缺乏衛教輔助工具：沒有衛教單張、無衛教本。2.沒有統一照護方法。3.護理人員認知不足：不知道要如何做。針對問題進行改善對策：(1)製作衛教手冊；(2)製作衛教單張；(3)訂立重大腹部手術標準照護流程；(4)定期舉辦讀書會。配合改善專案措施之後，病患對護理照護滿意度提昇至4.8分，護理人員對衛教一致性的提高至95%；藉由本專案適時性的介入初期腸道營養的照護措施，使患者早期恢復腸道功能，回歸日常生活。

The gastrointestinal tract is the major site where the digestion of food and absorption of dietary nutrients occurs. After undergoing major abdominal surgery, there is a requirement for five or more days of enforced fasting that allows the gastrointestinal tract to rest and gradually return to normal functioning. During this time, nursing staff play an important role as educator and instructor of the patient. However, there are various changes that occur when patients undergo critical abdominal surgery. The nursing personnel in our unit considered that the current initial gastrointestinal dietary management and nursing care guidelines were inadequate. This served as a strong motive to carry out this study in order to improve the quality of management. The hope was that utilization of the results of this study would improve initial gastrointestinal dietary management and nursing care among patients who underwent major abdominal surgery. This project covered the period between March 1, 2007 and March 31, 2007. The patients involved were questioned after major abdominal surgery using a survey that measured satisfaction with our nursing care score. The mean score was 3.2 out of a total of a possible total X points. We also found out that the consistency of the initial gastrointestinal dietary education given by our nurses was around 38%. These results clearly demonstrated that there is inadequate patient education in this area. After analysis, we established a number of outstanding problems that need answers. These problems were: 1) a lack of sufficient available instructional tools for the nursing staff to use; 2) .the fact that there was no unified system of nursing care and 3) the lack of a specifically assigned person to provide the patients with the training. With these problems in mind, we have established an improved approach that helps to answer these difficulties. These are, firstly, the creation of a health education handbook, secondly, the provision of instructional tools, thirdly, the establishing of a flowchart to control standard nursing care and finally, regular tutorials and information sharing sessions among the nursing staff. After the implementation of the above changes, there was a major improvement in patient satisfaction with the score for nursing care increasing to 4.8 and at the same time, the consistency in terms of dietary instruction rose to 95%. Specifically, there had been a vast improvement in the quality of our nursing care. This project had allowed the introduction of appropriate ways of improving initial gastrointestinal tract dietary management and nursing care, which will be of significant benefit to the patient, helping them towards a quick recovery and a return to their normal activities.