北歐式健走介入心衰竭患者提升六分鐘步行能力之實證照護

Evidenced-Base Nursing of Nordic Walking Exercise Intervention for Patients with Heart Failure to Promote Six-Minute Walking Ability

心臟疾病是全球和臺灣地區民眾十大死因的第二位，臺灣約79萬人罹患心衰竭，導致心輸出量不足而引起呼吸困難、活動無耐力等症狀，心臟復健運動可增加肌耐力和活動能力。但於疾病急性期，患者會因活動無耐力導致運動強度受限，進而影響復健成效。本個案是一位診斷急性心衰竭的患者，因心輸出量不足導致活動無耐力的護理問題，對患者的日常活動影響甚大。因此，筆者運用實證護理探討北歐式健走是否有效提升患者六分鐘步行能力。故搜尋PubMed, Cochrane Library及CINAHL等實證文獻資料庫，使用關鍵字＂heart failure＂, ＂Nordic walking＂, ＂six-minute walk＂之MeSH terms及其同義詞，搜尋2011年1月至2021年1月之英文實證文獻，最後萃取2篇心衰竭患者北歐式健走提升六分鐘步行能力之文章納入分析，並以臨床隨機試驗之評讀工具查核文獻，比較研究之完整性與品質，結果發現具北歐式健走杖認證資格的物理治療師教導心衰竭患者北歐式健走杖的使用方式，執行2次/週、1小時/次，持續12週能有效提升六分鐘步行能力。北歐式健走是一項無副作用、簡便的復健方式。期望藉此實證案例照護經驗，提供醫護人員針對心衰竭患者的臨床照護需求，運用實證技巧執行最佳的醫療照護。

According to 2019 statistics, chronic heart disease ranked second among the leading causes of death in Taiwan and global. About 790,000 people in Taiwan suffer from heart failure, leading to insufficient cardiac output and causing symptoms, such as dyspnea and activity intolerance. Although cardiac rehabilitation can increase muscle endurance and activity ability, a patient´s exercise intensity will be limited in the acute stage of the disease due to lack of endurance, thereby affecting the effectiveness of rehabilitation. The case, in particular, is a patient diagnosed with acute heart failure. Meanwhile, the nursing problem concerning the lack of endurance due to insufficient cardiac output has a great impact on the patient´s daily activities.Therefore, the author used evidence-based nursing to explore whether Nordic walking exercise can promote patients´ six-minute walking ability. This study searched databases, such as PubMed, Cochrane Library, and CINAHL, and used the keywords“heart failure＂,“Nordic walking＂,“six-minute walk＂MeSH terms and synonyms to search empirical literature in English from January 2011 to January 2021. Lastly, this study extracted 2 literatures on promoting the sixminute walking ability of patients with heart failure by Nordic walking for analysis. This study used CASP to inspect literature and compare the completeness and quality of studies. The results showed that after the physiotherapists with Nordic walking poles certification taught the patient with heart failure in using Nordic walking to perform the walking twice a week and 1 hour/time for 12 weeks, it can effectively promote the patient´s six-minute walking ability. Therefore, Nordic walking is a simple and convenient way of rehabilitation without side effects. It is expected that through this evidence-based nursing experience, medical and nursing personnel can use evidence-based techniques that to perform the best medical care to meet the clinical care needs of patients with heart failure.