運用多元教學策略改善血液透析病人自我照顧動靜脈瘻管能力

Multimodal Educational Strategies to Improve Arteriovenous Fistula Self-Care in Hemodialysis Patients

動靜脈瘻管為血液透析病人維持治療的重要生命線，若照護不當，易導致功能不良甚至衰竭。近期單位病人瘻管異常發生率上升，經專案小組事件分析後發現，病人自我照護能力平均僅48%。問題主因包括：病人缺乏瘻管照護相關知識、護理人員衛教內容不足、教育訓練與標準作業規範不全，以及稽核制度與指導工具不健全。為改善上述問題，專案團隊規劃並執行多元改善策略，包括病人團體護理指導、護理人員情境模擬與翻轉式教育訓練、製作虛擬互動教材與多媒體影音教學工具，並建置標準化指導流程與稽核機制。實施後結果顯示，血液透析病人之動靜脈瘻管自我照護能力，由48%顯著提升至95.9%，顯示介入成效良好。此結果證實多元教學策略的導入，能有效增進病人自我照護能力，提升病人安全，並優化透析照護品質。

The arteriovenous fistula (AVF) serves as a vital lifeline for patients undergoing hemodialysis, yet improper care can lead to dysfunction or failure. Recently, an increased incidence of AVF complications was observed in our unit. Event analysis conducted by the project team revealed that patients’average self-care ability was only 48%. The root causes included insufficient patient knowledge of fistula care, inadequate nursing instruction, lack of standardized education and training protocols, and incomplete auditing systems and educational tools. To address these issues, the project team implemented a series of multifaceted improvement strategies, including group nursing education for patients, scenario-based simulation and flipped learning for nursing staff, the development of virtual interactive materials and multimedia video teaching tools, and the establishment of standardized guidance procedures and audit mechanisms. After implementation, the self-care ability of hemodialysis patients regarding AVF care significantly improved from 48% to 95.9%, demonstrating the effectiveness of the interventions. The results confirm that the integration of diverse educational strategies can effectively enhance patients’self-care ability, improve patient safety, and optimize the quality of hemodialysis care.