全人照護及其教育訓練與評值

<p>目的：全人照護是對病人身體、心理、社會層面及靈性全面照護的態度與行為，需要醫療院所投注多專 業、跨領域且有效率又有品質的整合服務，才能滿足病人「一站式服務、一次購足」的需求。本文之目的在於詮釋全人照護之真諦、內涵、教育訓練與評值。</p> <p>方法：藉由闡釋全人照護的素養與能力，強調推廣全人照護需要多面向的教育訓練加以養成，並發展以能力為基礎的評值方法。</p> <p>結果：醫療人員需要終身持續學習有關全人照護的核心知識與技能、醫療專業照護、同理心與心理支持、就醫行為和家庭照護，以及生命關懷及和臨終照護，並佐以適合及一致性的評值標準，方能系統性的推廣全人照護。</p> <p>結論：本文探討全人照護的真諦、如何推動全人照護及如何實施全人照護之教育訓練與評值，作為醫療院所推動全人照護之參考。</p> <p>&nbsp;</p><p>Objective: Holistic care is an approach that involves consideration of the physical, emotional, social, and spiritual wellbeing of a patient. It involves multidisciplinary, interprofessional integrated teams with members who educate, cooperate with, and respect each other to offer one-stop fulfillment of patient needs. This article explains the core values and intentions of holistic care and the relevant education, training, and assessments.</p> <p>Methods: By explaining the competencies of holistic care, this article argues that the promotion of holistic care necessitates multidimensional education, training, and competency-based assessments.</p> <p>Results: To systematically promote holistic care, accompanied by appropriate and consistent assessment standards, health care providers must continue to learn about the main components of holistic care, including its required knowledge and competencies, professional medical care empathy and psychological support, the praxeology of healthcare seeking, family care, and end-of-life and hospice care.</p> <p>Conclusion: This article discusses the core values of holistic care; how to promote holistic care; and how to implement education, training, and assessments in the field of holistic care and may therefore serve as a reference for holistic care training in medical settings.</p> <p>&nbsp;</p>

96小時重置周邊靜脈導管之效應：資料庫分析

<p>目的：透過異常通報資料庫分析，探討96小時對照72小時重置周邊靜脈導管，對於靜脈炎發生率之影響。</p> <p>方法：方便取樣臺灣南部某醫學中心之異常通報資料庫，分析2011年9月1日至2014年8月31日之72小時重置組，與2014年9月1日至2017年8月31日之96小時重置組，2個時期之住院個案的靜脈炎發生率。</p> <p>結果：96小時對照72小時重置周邊靜脈導管，並未增加靜脈炎發生率。靜脈炎總發生率（勝算比[odds ratio,OR] = 0.70, p=.0290）與細菌性靜脈炎發生率(OR= 0.11, p=.0097)顯著減少，化學性與機械性靜脈炎發生率則無顯著差異。</p> <p>結論：本土性資料庫分析結果為在臺灣熱帶海島型潮濕氣候，三班評估無靜脈炎症狀下，96小時重置周邊靜脈導管並不會顯著增加靜脈炎風險，建議醫療機構可據此調整臨床作業規範，落實實證知識轉譯。</p> <p>&nbsp;</p><p>&quot;Purpose: To compare the effect of replacement of peripheral venous catheters at 96-hour intervals on the incidence of phlebitis with that at 72-hour intervals through analysis of an incident-reporting database.</p> <p>Methods: Convenience sampling of records from the incident-reporting database of a medical center in southern Taiwan was used to analyze the incidence of phlebitis among hospitalized patients with replacement of peripheral venous catheters at 72-hour intervals (from September 1, 2011, to August 31, 2014) or 96-hour intervals (from September 1, 2014, to August 31, 2017).</p> <p>Result: The analysis revealed that replacing peripheral venous catheters every 96 hours rather than every 72 hours did not increase the incidence of phlebitis. The total incidence of phlebitis (odds ratio [OR]=0.70, p=.0290) and the incidence of bacterial phlebitis (OR=0.11, p=.0097) decreased significantly, and no significant differences in the incidence rates of chemical or mechanical phlebitis were identified.</p> <p>Conclusion: According to the analysis results of a local database, under the humid tropical insular climate of Taiwan, replacement of peripheral venous catheters at 96-hour intervals did not significantly increase the risk of phlebitis in patients who exhibited no symptoms of phlebitis as assessed in three shifts. Medical institutions can adjust their clinical operation standards and implement knowledge translation accordingly.</p> <p>&nbsp;</p>

運用品管手法改善藥師在職教育課程的辦理成效

<p>目的：改善在職教育課程的辦理成效，期能強化部內藥事人員專業技能以提升病人的照護品質。</p> <p>方法：本專案結合Kern課程規劃循環(Kern curriculum cycle)與品管手法PDCA的概念，由課堂的課後資料與 問卷進行現況分析與學習者需求調查，找出「課程參與度與完成度低」之主要因，並擬定對策。課程參與度之目標設定為每堂課平均出席人數過半達64位，課程完成率達85%。（課程完成之定義為限期內完成課後評值且分數高於80分，以及滿意度填寫）</p> <p>結果：課程內容與品質改善後，平均出席人數由56位增加到65位，目標達成率112.5%；課程完成率由83.2%增加到87.3%，目標達成率227.8%。</p> <p>結論：藉由優化課程內容與品質，改善在職教育課程的辦理成效，進一步再將特定發展的課程主題以帶狀系列或社群模式進行，能提高同仁自主學習意願、促進自我成長，亦能強化同仁專業技能，進而提升病人照護品質，且有助於部門內人才師資培育兼顧員工職涯發展，並預做準備將全人照護概念向下扎根於藥學實習生。</p> <p>&nbsp;</p><p>Objective: To improve the effectiveness of on-the-job education programs for strengthening the professional skills of the pharmacists in our department and further enhance the quality of patient care.</p> <p>Methods: This project integrated the Kern curriculum cycle and the Plan-Do-Check-Act (PDCA) concept of quality control. We used post-class evaluations and questionnaires to do a situation analysis and survey learners’ needs to identify the main reasons for low course participation and completion and to develop countermeasures to these problems. The course participation targets were an average attendance of 64 pharmacists per class and a course completion rate of 85%. Course completion was defined as completing both the postcourse evaluation (80 points to pass) and the satisfaction questionnaires by the stipulated deadline.</p> <p>Results: After we improved the content and quality of the courses, the average attendance increased from 56 to 65, and the target achievement rate was 112.5%. In addition, the course completion rate increased from 83.2% to 87.3%, and the target achievement rate was 227.8%.</p> <p>Conclusion: By optimizing the content and quality of the courses, improving the effectiveness of the on-the-job education programs, and developing courses on specific topics within a series or community model, we cultivated independent learning and self-growth among our pharmacists, strengthened their professional skills, and improved the quality of patient care. Moreover, talents and teachers were fostered while taking into account the career development of our pharmacists, and preparations were made to root the concept of holistic care down in pharmacy interns.</p> <p>&nbsp;</p>