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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 蔡娟秀 | 個別與整合性的照護措施對降低護理之家尿失禁之成效探討 | 2010/2/25 上午 10:02:45 | 0 |
| 原 文 | 題 目 | Can an individualized and comprehensive care strategy improve urinary incontinence (UI) among nursing home residents? |
| 作 者 | Tanaka, Yukiko; Nagata, Kumiko; Tanaka, Tomoe; Kuwano, Koichi; Endo, Hidetoshi; Otani, Tetsuya; Nakazawa, Minato; Koyama, Hiroshi. | |
| 出 處 | Archives of Gerontology & Geriatrics, | |
| 出版日期 | Sep2009, Vol. 49 Issue 2, p278-283, | |
| 評 論 |
隨著長期照護保險即將實施，如何提升長期照護的品質成為被矚目的焦點。由於失禁會造成跌倒、感染與皮膚完整性受損等問題，因此護理之家的失禁防治在照護指引中也被列為重要的項目. 本篇論文針對17家護理之家1290個案收案，最後收案為153名老人。研究團隊除了一般的排尿訓練之外，針對虛弱老人提供整體性的評估與各別處遇計畫。治療活動包含飲食、液體1500cc、至廁所解尿、每天至少離床六小時與減少在潮濕尿布浸潤的時間。此研究採取行動研究策略，先跟機構解釋、與主管及照護人員充分溝通、接著強調病人鼓勵與工作人員支持的重要性。在經過12週的措施之後，病人的喝水量、尿布使用量、與夜間尿布用量都有顯著的下降，結果顯示有效的個人處遇措施，可以減少護理之家病人失禁的情形。 在限制方面，由於本篇的目標族群與最後收案的個案落差頗大，顯示護理之家相關的治療活動執行不易，而且由於是行動研究，並不是隨機控制的臨床試驗，因此如果更能擴充為成效評價性研究，更能落實轉譯研究的效力。 |
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| abstract | Urinary incontinence (UI) is one of the most common and distressing conditions among nursing home residents. Although scheduled care is usually provided for them, incontinence care should be individualized regarding going to the toilet, changing diapers, and taking food and water. We have developed an individualized and comprehensive care strategy to address the problem. We conducted an intervention study that involved training chiefs of staffs, who in turn trained other staffs, and encouraging residents. A total of 153 elderly subjects ed from 1290 residents in 17 nursing homes were eligible to receive our individualized and comprehensive care. The goals of the care strategy were (i) to complete meal intake; (ii) to take fluids up to 1500ml/day; (iii) to urinate in a toilet; (iv) to spend over 6h out of bed; and (v) to reduce time spent in wet diapers. We explained the aims of our strategy to the chiefs of staff of each nursing home and instructed them to encourage residents to take an active part in our individualized and comprehensive care strategy for 12 weeks. For 3 days before and after that period, we assessed the changes in fluid volume intake, time spent in wet diapers, size of diaper pads, and urination habits. The result was that fluid volume intake significantly increased (p <0.001) while time spent in wet diapers decreased (p <0.001). The number of residents wearing diapers decreased as did the size of pads during the day (p =0.0017). The proportion of residents using diapers at night was reduced and those using toilets at night increased (p =0.007). This study suggests that such an individualized and comprehensive care strategy can offer a measurable improvement in UI care. | |
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