顛覆傳統思維──以擬真教學提升護理師於胃食道球照護完整性之專案

Challenging Conventional Norms: Enhancing Comprehensiveness of Nursing Care in Sengstaken-Blakemore Tube Placement Through Simulation Teaching

目的
食道靜脈曲張破裂出血為肝硬化疾患最常見的高危合併症。此時護理師能否順利協助醫師緊急放置胃食道球，並正確執行照護措施，成為攸關病人生命安全的重要關鍵。經專案小組調查發現，加護病房護理師之胃食道球照護認知的正確率僅為40％，主因為護理師不熟悉用物準備與照護重點，且較少實務操作經驗、缺照護指引，以及教具演練、學習管道，因此感到焦慮且不知所措，故成立專案小組改善。
方法
透過擬真教學策略搭配3D列印人體教具、設計專用收納盒、制定照護指引手冊及教學影片等教學工具，設計在職教育及實際演練課程，來提升護理師對胃食道球照護認知之正確率，進而達到胃食道球照護的完整性。教育訓練的過程中，藉由Socrative互動式教學軟體，增加臨床護理師參與感及學習成效。
結果
本專案改善策略實施後，護理師之胃食道球放置及臨床照護認知正確率由40％提升至84％、胃食道球照護完整性由55％提升至96％。
結論
擬真教學搭配3D列印人體教具，已提升護理師對於胃食道球照護完整性，期望藉此分享作為學習指南，互相精進成長。

Purposes
Bleeding resulting from ruptured gastroesophageal varices stands as the most common high-risk complication of hepatic cirrhosis. In the interest of patient safety, registered nurses must be able to adeptly assist physicians in the placement of the Sengstaken-Blakemore (SB) tube and effectively administer patient care. An investigation revealed that only 40% of registered intensive care nurses possess the requisite knowledge and skills to deliver competent SB tube care. Some of the main reasons for this knowledge gap are the lack of familiarity with the preparations, deficiencies in the core aspects of care, limited clinical experience, absence of guidance, and a dearth of practice devices and training, culminating in anxiety and helplessness among nurses in clinical practice. To address these challenges, we devised an intervention aimed at improving the competency of registered nurses in providing care through the use of the SB tube.
Methods
The intervention included simulation teaching that incorporated three-dimensional (3D)-printed teaching aids of the human body, along with various tools such as a custom-designed storage box, care guidelines, and instructional videos. These elements were integrated into on-the-job training and practice courses aimed at enhancing registered nurses’knowledge base and improving the comprehensiveness of SB tube care. Additionally, the interactive software Socrative was used to bolster participation and effectiveness in learning among registered nurses.
Results
Following the intervention, the percentage of registered nurses proficient in SB tube care increased from 40% to 84%, and the proportion of those providing comprehensive care to patients using the SB tube increased from 55% to 96%.
Conclusions
Simulation teaching, enhanced by 3D-printed teaching aids, effectively improved registered nurses’skills in delivering comprehensive care through the SB tube. The proposed clinical training program could serve as an educational model to cultivate proficiency in SB tube care among registered nurses and inspire advancements in nursing education.