以專科護理師的角色提昇早產兒臨床照護成果初探

Promote the Model of Premature and the Family care by Nurse Specialists

由於全民健保的實施，以往無法接受昂貴醫療費用救治的早產兒得以存活下來，再加上新生兒醫學科技的進步，使得早產兒正常生長發育的機會大大提升，但對於照護者而言卻是一種不可言諭的壓力，從住院到出院、返家的每一階段，都是一大挑戰，然而臨床護理人員常礙於人力不足，忙碌於常規工作，對出院準備服務的執行較不易落實。因此本病室於2003年經由新生兒科專科護理師角色的設立，推行早產兒出院準備服務及個案管理照護模式。自2003年10月至2004年10月為期一年間，將懷孕週數＜37週、出生體重≧2000公克者列為出院準備服務對象；懷孕週數＜37週、出生體重＜2000公克或出生體重≧2000公克但有腦部合併症者，列為個案管理的對象，共計個案153位，其中列為出院準備服務早產兒組有60位，列為個案管理收案的早產兒組有93位。個管組早產兒常見的居家照護問題，以餵食及排泄問題居多，針對這些問題，專科護理師於電訪中提供照護者解決方法，必要時轉介門診或相關單位接受進一步的醫療處置，並持續電訪追蹤後續照護情形。由於專科護理師於住院期間與照護者建立良好的醫病關係及信任感，增加照護者主動來電諮詢的意願，更能適時適切的解決居家照護問題，充分發揮專科護理師獨特的角色功能，協助早產兒及其家庭度過每一階段之危機，確實提升早產兒醫療照護的品質。

The number of premature survivals has dramatically increased since the National Health Insurance Program was implemented. In the past, the procedure was costly and time consuming. Not every family could afford, but now it is all covered by Insurance with more advanced medical treatments. It was also a big challenge to those caretakers having no expertise on this area. They used to work under pressure from the first day of the premature returning home. Due to the lack of resources in terms of providing the guidance and knowledge for those outpatients, the NBR of Taipei Veterans General Hospital initiated a new project in 2003 to form a team of nurse specialists to dedicate their efforts at this area. By exercising their unique role and expertise, they were not only able to assist the premature and their family to overcome various stages of crises, but also turn the crises into opportunities of uplifting the quality of caring for the premature. Given below is the statistic from what we did during October 2003 to October 2004, while we categorized our patients into two groups. The first group was called discharge planning group for those pregnant less than 37 weeks and the premature over 2000g; the second group was called case manager group for those pregnant less than 37 weeks or the premature over 2000g, but they had brain complications. The total number of patients we had in this period was 153, including 60 in discharge planning group and 93 in case manager group. For those in case-study group, we made an average of 2-8 phone calls to follow up understanding the issues they faced. Among those phone calls, the most common questions they asked were how to feed and eliminate guestions, etc. We were also able to remind them for the areas they neglected or evaluated if the patients needed to see the doctor for advanced treatments. By doing this way, it dramatically reduced the number of sending them back to hospital. We built up very good and trustful relationships between patients, nurse specialists, and doctors. We also provided a hot-line for those who needed our assistants immediately. Since 2003, all records have been proving our project successful and the high quality of our service.