提升居家護理師執行個案關節活動度測量完整性

Improvement of Integrity in Passive Range of Motion Exercise Assessment among Home Care Nurses

臺灣人口快速老化，老人常因慢性病導致失能，致日常生活需要他人協助。文獻 指出，肢體若 3 天沒有活動，就可能出現肌肉攣縮、關節僵硬，故居家照護重點包括 指導關節運動執行以維持關節功能角度，避免因制動而導致關節攣縮影響日常生活照 顧。臨床發現護理師訪視皆能主動指導及協助執行被動／主動關節運動，但並未測量關 節角度及測量方法不一致，查核紀錄發現關節活動紀錄完整性僅 66.7%，關節活動測 量認知正確性僅 63.3%，關節活動測量技能正確性僅 75.0%，透過與物理治療師跨團 隊合作共同討論改善策略，設立「關節活動度測量標準作業指引」及舉辦教育訓練， 增設便利攜帶的彩色版關節活動度簡易測量表，以相片示範個案關節活動測量方式， 提升人員對關節活動度測量認知、技能正確性及記錄完整性，並透過持續性監控，確 實有助提升人員執行關節活動度測量完整性，讓人員能事半功倍有效的完成關節活動 度測量，以提供更適切的照護。專案實施成效良好，建議其他居家護理亦能主動評估 個案關節活動度，早期介入物理治療，並持續追蹤紀錄個案關節活動度，以維持個案 最佳功能狀態，提升居家護理個案生活品質。

The latest data from Ministry of Interior revealed that we were approaching aged society as there were over three million, comprised of 12.83% of total population, of elderly in 2016. As people aging rapidly, there were more disabilities caused by chronic diseases and injured thus more dependency in daily living. According to the previous study, muscle atrophy and joint stiffness might occur for as short as 3 days of inactivity, and it was more vulnerable for those bed-ridden patients thus affected their daily care. Therefore, the focus of home care services should also include the guidance of passive range of motions (PROM), continuous follow up of the implementation of rehabilitations to ensure joint motion maintenances, avoiding atrophy caused by inactivity and deterioration of daily activities of care (such as clothing, bathing, get out of bed and etc.), resulting in injuries of the cases. Practically, our home care nurses were proactively provided caregivers with guidance in active and passive range of motions. Inconsistent in range of motion criterion and assessment had leaded to disappointing integrity in PROM record, knowledge of assessment, and accuracy in PROM performance, with 66.7%, 63.3% and 75.0%, respectively. A trans-disciplinary co-operation with physical therapist, the Guideline on Performing Passive Range of Motion (PROM) was established and related training was carried out to improve the integrity. By providing color version of PROM assessment table with pictures demonstration and brief method, the preciseness on PROM measurement, knowledge and skill, as well as integrity on PROM assessment record increased, to 100%. The initiative of continuous supervision helped improved integrity and effectiveness of PROM performed by home care nurses thus provided more appropriate care. The Guideline on Performing Passive Range of Motion (PROM) had been included as conventional in our unit due to its excellent effectiveness. It was suggested that trans-disciplinary co-operation with proactive range of motions assessment, early physical therapy intervention and continuous follow up were critical to maintain functional ability of the cases and thus improved their quality of life.