血液透析護理人員執行高血磷護理指導完整性之改善方案

Promoting the Nursing Instruction for Hemodialysis Patients with Hyperphosphatemia

一致及完整的高血磷護理指導，有助於協助透析病人血清磷值之控制。經現況分析，發現因護理人員對高血磷認知不足、缺乏相關在職教育、護理指導工具不足、缺乏護理指導標準規範與稽核制度，導致單位護理人員執行透析病人高血磷護理指導之完整率僅53.1%。經實施改善方案：舉辦在職教育、製作護理指導工具、建立護理指導標準作業規範、舉辦情境模擬演練、製作護理指導學習影片、建立個案護理師制度、進行護理指導稽核。高血磷護理指導完整性由53.1%提升至96.5%；護理師對高血磷之認知由61.5%提升到96.7%；門診透析病人血清磷≧6.0mg/dl之人數，由30.7%降至19.3%，顯示落實護理指導有助於降低病患之血磷數值。 Consistent and comprehensive nursing instruction regarding prevention of hyperphosphatemia facilitates patients who have underwent hemodialysis. Analysis of the conditions revealed that nurses attained a 53.1% completion rate in nursing instructions due to insufficient knowledge, lack of continuous education, inadequate nursing instruction tools and materials, a lack of standard operating procedures (SOPs), and an audit/review system for relevant nursing instructions. Strategies for improvement were proposed as follows: providing continuous education regarding hyperphosphotemia, creating nursing instruction tools and materials, establishing nursing instruction SOPs, implementing practical simulation training, creating nursing instruction films, developing a case nurse system and reviewing nursing instructions . After implementing the strategies, the completeness Of nursing instructions increased from 53.1% to 96.5%. The percentage of nurses knowledgeable of hyperphosphatemia increased from 61.5% to 96.7%, with the percentage of outpatients with a serum phosphate level of 6.0 mg/dL or higher reduced from 30.7% to 19.3%, revealing that the improved and completed nursing instructions were conducive to reducing the serum phosphate levels of hemodialysis patients.

Consistent and comprehensive nursing instruction regarding prevention of hyperphosphatemia facilitates patients who have underwent hemodialysis. Analysis of the conditions revealed that nurses attained a 53.1% completion rate in nursing instructions due to insufficient knowledge, lack of continuous education, inadequate nursing instruction tools and materials, a lack of standard operating procedures (SOPs), and an audit/review system for relevant nursing instructions. Strategies for improvement were proposed as follows: providing continuous education regarding hyperphosphotemia, creating nursing instruction tools and materials, establishing nursing instruction SOPs, implementing practical simulation training, creating nursing instruction films, developing a case nurse system and reviewing nursing instructions . After implementing the strategies, the completeness Of nursing instructions increased from 53.1% to 96.5%. The percentage of nurses knowledgeable of hyperphosphatemia increased from 61.5% to 96.7%, with the percentage of outpatients with a serum phosphate level of 6.0 mg/dL or higher reduced from 30.7% to 19.3%, revealing that the improved and completed nursing instructions were conducive to reducing the serum phosphate levels of hemodialysis patients.