Family nurse practitioners (FNPs) have the potential to provide holistic and family-centered care in Taiwan. This article aims to apply complexity science and systems thinking to the lack of FNPs in Taiwan. The complex problem of having no FNPs and its associated contributing factors are described and visualized through various causal links, patterns, the “fixes that fail” archetype, and the mental model. Based on the authors’analysis of the problem, a multifaceted intervention is recommended.
{"title":"Potential New Role: Family Nurse Practitioner in Taiwan","authors":"童恒新 童恒新, 蔡秀鸞 Heng-Hsin Tung, 魏倩雯 Shiow-Luan Tsay, Shu-Fen Shen Ching-Wen Wei, 盧怜君 Shu-Fen Shen, Mei-Fang Chuang Ling-Chun Lu","doi":"10.53106/2410325x2021120802001","DOIUrl":"https://doi.org/10.53106/2410325x2021120802001","url":null,"abstract":"\u0000 Family nurse practitioners (FNPs) have the potential to provide holistic and family-centered care in Taiwan. This article aims to apply complexity science and systems thinking to the lack of FNPs in Taiwan. The complex problem of having no FNPs and its associated contributing factors are described and visualized through various causal links, patterns, the “fixes that fail” archetype, and the mental model. Based on the authors’analysis of the problem, a multifaceted intervention is recommended.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133727886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.53106/2410325x2021120802003
張瑀玲 張瑀玲
專科護理師在台灣發展近30年，過去的專科護理師培訓以專業知識為主，以符合臨床照護需求。近年來，專科護理師的角色逐漸被重視，開始擔負起在專科護理師領域的領導者角色，但每家醫院對專科護理師的要求標準不一致，除擔任專科護理師行政管理者的工作外，亦須同時兼顧臨床專科護理師的角色，繁重的行政工作造成專科護理師主管相當大的工作負荷，例如處理人力短缺、排班、留任、訓練、考核等，同時執行臨床照護與行政管理的工作，造成專科護理師擔任行政主管的意願不高。因此，專科護理師學會規劃領導系列培訓課程，期望能增進專科護理師行政主管的領導能力，除了在醫院帶領專科護理師的專業發展，也期許發揮影響力能讓世界看見台灣專科護理師。 The development of nurse practitioner in Taiwan has been more than thirty years. Several reasons were behind the beginning of the nurse practitioner development, including the shortfall of resident doctors, lacking of nursing professional autonomy, and shortage of preceptor in advanced nursing. As a result, the doctors were responsible for the training program. After the laws were established to regulate the role of nurse practitioner with efforts from the government and scholars supporting the nurse practitioner education, many preceptors as trainees of nurse practitioner became important roles as instructors in hospitals. Taiwan’s nurse practitioner education mainly provided in hospital because the demand for nurse practitioner is still increasing in medical system and this phenomenon is a far cry from the overseas nurse practitioner training programs, which are provided in the higher education.The design of the nurse practitioner training program should base on the core competencies, and the advanced nursing curriculum should include 3Ps, such are physical assessment, pathology and pharmacology.Can the short-term hospital training program meet the expectation? Therefore, this study aims to introduce the origins of the hospital training system for nurse practitioners in Taiwan, the content of the training curriculum and the core competencies of the nurse practitioner. By doing so, we hope the readers can extend the discussion on the hospital training program to a wider scope.
专科护理师在台湾发展近30年，过去的专科护理师培训以专业知识为主，以符合临床照护需求。近年来，专科护理师的角色逐渐被重视，开始担负起在专科护理师领域的领导者角色，但每家医院对专科护理师的要求标准不一致，除担任专科护理师行政管理者的工作外，亦须同时兼顾临床专科护理师的角色，繁重的行政工作造成专科护理师主管相当大的工作负荷，例如处理人力短缺、排班、留任、训练、考核等，同时执行临床照护与行政管理的工作，造成专科护理师担任行政主管的意愿不高。因此，专科护理师学会规划领导系列培训课程，期望能增进专科护理师行政主管的领导能力，除了在医院带领专科护理师的专业发展，也期许发挥影响力能让世界看见台湾专科护理师。 The development of nurse practitioner in Taiwan has been more than thirty years. Several reasons were behind the beginning of the nurse practitioner development, including the shortfall of resident doctors, lacking of nursing professional autonomy, and shortage of preceptor in advanced nursing. As a result, the doctors were responsible for the training program. After the laws were established to regulate the role of nurse practitioner with efforts from the government and scholars supporting the nurse practitioner education, many preceptors as trainees of nurse practitioner became important roles as instructors in hospitals. Taiwan’s nurse practitioner education mainly provided in hospital because the demand for nurse practitioner is still increasing in medical system and this phenomenon is a far cry from the overseas nurse practitioner training programs, which are provided in the higher education.The design of the nurse practitioner training program should base on the core competencies, and the advanced nursing curriculum should include 3Ps, such are physical assessment, pathology and pharmacology.Can the short-term hospital training program meet the expectation? Therefore, this study aims to introduce the origins of the hospital training system for nurse practitioners in Taiwan, the content of the training curriculum and the core competencies of the nurse practitioner. By doing so, we hope the readers can extend the discussion on the hospital training program to a wider scope.
{"title":"台灣專科護理師醫院培訓現況","authors":"張瑀玲 張瑀玲","doi":"10.53106/2410325x2021120802003","DOIUrl":"https://doi.org/10.53106/2410325x2021120802003","url":null,"abstract":"\u0000 專科護理師在台灣發展近30年，過去的專科護理師培訓以專業知識為主，以符合臨床照護需求。近年來，專科護理師的角色逐漸被重視，開始擔負起在專科護理師領域的領導者角色，但每家醫院對專科護理師的要求標準不一致，除擔任專科護理師行政管理者的工作外，亦須同時兼顧臨床專科護理師的角色，繁重的行政工作造成專科護理師主管相當大的工作負荷，例如處理人力短缺、排班、留任、訓練、考核等，同時執行臨床照護與行政管理的工作，造成專科護理師擔任行政主管的意願不高。因此，專科護理師學會規劃領導系列培訓課程，期望能增進專科護理師行政主管的領導能力，除了在醫院帶領專科護理師的專業發展，也期許發揮影響力能讓世界看見台灣專科護理師。\u0000 The development of nurse practitioner in Taiwan has been more than thirty years. Several reasons were behind the beginning of the nurse practitioner development, including the shortfall of resident doctors, lacking of nursing professional autonomy, and shortage of preceptor in advanced nursing. As a result, the doctors were responsible for the training program. After the laws were established to regulate the role of nurse practitioner with efforts from the government and scholars supporting the nurse practitioner education, many preceptors as trainees of nurse practitioner became important roles as instructors in hospitals. Taiwan’s nurse practitioner education mainly provided in hospital because the demand for nurse practitioner is still increasing in medical system and this phenomenon is a far cry from the overseas nurse practitioner training programs, which are provided in the higher education.The design of the nurse practitioner training program should base on the core competencies, and the advanced nursing curriculum should include 3Ps, such are physical assessment, pathology and pharmacology.Can the short-term hospital training program meet the expectation? Therefore, this study aims to introduce the origins of the hospital training system for nurse practitioners in Taiwan, the content of the training curriculum and the core competencies of the nurse practitioner. By doing so, we hope the readers can extend the discussion on the hospital training program to a wider scope.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132567121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.53106/2410325x2021120802009
錢玉治 錢玉治, 黃雅君 Yu-Chih Chien, 翁嘉澤 Ya-Chun Huang
本文描述一位32歲女性病患，罹患全身性紅斑性狼瘡已有11年，規則於門診追蹤，因發燒、關節痛、胸痛，實驗室檢查發現貧血、血小板低下、補體（C3）低下、高效價之抗雙股去氧核糖核酸抗體（anti-dsDNA > 379 IU／mL）、尿液呈現蛋白尿，初步診斷懷疑全身性紅斑性狼瘡復發。靜脈注射高劑量methylprednisolone七天，血小板仍偏低，治療反應差。本個案實驗室檢查顯示溶血性貧血、血小板低下、週邊血液抹片顯示碎裂紅血球，確定微血管性溶血性貧血證據，且血液中ADAMTS 13嚴重缺乏其血中活性為0%，因此診斷為血栓性血小板低下紫斑症。緊急接受血漿置換術，同時持續高劑量類固醇與靜脈注射Rituximab治療，因而血小板上升、乳酸脫氫脢大幅下降、貧血改善，達到治療的成效。全身性紅斑性狼瘡同時出現血栓性血小板低下紫斑症，經緊急啟動血漿置換，會降低病人的死亡率。 A 32-year-old female patient in this study, who suffered from systemic lupus erythematosus (SLE) for 11 years. Upon a regular rheumatology outpatient follow-up, she presented not only with fever,arthralgia and chest pain, but also with anemia, low platelets, low complement (C3), and high titer anti-double-strand deoxyribonucleic acid antibody (anti-dsDNA > 379 IU/mL) on laboratory test report,as well as proteinuria on urinalysis. Accordingly, her condition was suspected to be a relapse of SLE. Unfortunately, after treatment with high-dose intravenous methylprednisolone, the response was poor with persistent low platelet level. Besides, hemolytic anemia and thrombocytopenia were noted and peripheral blood smear examination also showed fragmented red blood cells, supporting the diagnosis of microangiopathic hemolytic anemia. Moreover, there was severe ADAMTS13 deficiency in the blood, even with 0% of activity. Therefore, the patient was finally diagnosed with thrombotic thrombocytopenic purpura and then received urgent plasmapheresis in combination with high-dose glucocorticoid and of intravenous rituximab treatment. After the treatment, the platelet level increased, lactate dehydrogenase level remarkably decreased, and anemia gradually improved. Taken together, urgent initiation of plasma exchange together with glucocorticoid and rituximab treatment for SLE patient with thrombotic thrombocytopenic purpura could lower the mortality rate.
本文描述一位32岁女性病患，罹患全身性红斑性狼疮已有11年，规则于门诊追踪，因发烧、关节痛、胸痛，实验室检查发现贫血、血小板低下、补体（C3）低下、高效价之抗双股去氧核糖核酸抗体（anti-dsDNA > 379 IU／mL）、尿液呈现蛋白尿，初步诊断怀疑全身性红斑性狼疮复发。静脉注射高剂量methylprednisolone七天，血小板仍偏低，治疗反应差。本个案实验室检查显示溶血性贫血、血小板低下、周边血液抹片显示碎裂红血球，确定微血管性溶血性贫血证据，且血液中ADAMTS 13严重缺乏其血中活性为0%，因此诊断为血栓性血小板低下紫斑症。紧急接受血浆置换术，同时持续高剂量类固醇与静脉注射Rituximab治疗，因而血小板上升、乳酸脱氢脢大幅下降、贫血改善，达到治疗的成效。全身性红斑性狼疮同时出现血栓性血小板低下紫斑症，经紧急启动血浆置换，会降低病人的死亡率。 A 32-year-old female patient in this study, who suffered from systemic lupus erythematosus (SLE) for 11 years. Upon a regular rheumatology outpatient follow-up, she presented not only with fever,arthralgia and chest pain, but also with anemia, low platelets, low complement (C3), and high titer anti-double-strand deoxyribonucleic acid antibody (anti-dsDNA > 379 IU/mL) on laboratory test report,as well as proteinuria on urinalysis. Accordingly, her condition was suspected to be a relapse of SLE. Unfortunately, after treatment with high-dose intravenous methylprednisolone, the response was poor with persistent low platelet level. Besides, hemolytic anemia and thrombocytopenia were noted and peripheral blood smear examination also showed fragmented red blood cells, supporting the diagnosis of microangiopathic hemolytic anemia. Moreover, there was severe ADAMTS13 deficiency in the blood, even with 0% of activity. Therefore, the patient was finally diagnosed with thrombotic thrombocytopenic purpura and then received urgent plasmapheresis in combination with high-dose glucocorticoid and of intravenous rituximab treatment. After the treatment, the platelet level increased, lactate dehydrogenase level remarkably decreased, and anemia gradually improved. Taken together, urgent initiation of plasma exchange together with glucocorticoid and rituximab treatment for SLE patient with thrombotic thrombocytopenic purpura could lower the mortality rate.
{"title":"一位年輕女性以貧血及血小板低下為表現","authors":"錢玉治 錢玉治, 黃雅君 Yu-Chih Chien, 翁嘉澤 Ya-Chun Huang","doi":"10.53106/2410325x2021120802009","DOIUrl":"https://doi.org/10.53106/2410325x2021120802009","url":null,"abstract":"\u0000 本文描述一位32歲女性病患，罹患全身性紅斑性狼瘡已有11年，規則於門診追蹤，因發燒、關節痛、胸痛，實驗室檢查發現貧血、血小板低下、補體（C3）低下、高效價之抗雙股去氧核糖核酸抗體（anti-dsDNA > 379 IU／mL）、尿液呈現蛋白尿，初步診斷懷疑全身性紅斑性狼瘡復發。靜脈注射高劑量methylprednisolone七天，血小板仍偏低，治療反應差。本個案實驗室檢查顯示溶血性貧血、血小板低下、週邊血液抹片顯示碎裂紅血球，確定微血管性溶血性貧血證據，且血液中ADAMTS 13嚴重缺乏其血中活性為0%，因此診斷為血栓性血小板低下紫斑症。緊急接受血漿置換術，同時持續高劑量類固醇與靜脈注射Rituximab治療，因而血小板上升、乳酸脫氫脢大幅下降、貧血改善，達到治療的成效。全身性紅斑性狼瘡同時出現血栓性血小板低下紫斑症，經緊急啟動血漿置換，會降低病人的死亡率。\u0000 A 32-year-old female patient in this study, who suffered from systemic lupus erythematosus (SLE) for 11 years. Upon a regular rheumatology outpatient follow-up, she presented not only with fever,arthralgia and chest pain, but also with anemia, low platelets, low complement (C3), and high titer anti-double-strand deoxyribonucleic acid antibody (anti-dsDNA > 379 IU/mL) on laboratory test report,as well as proteinuria on urinalysis. Accordingly, her condition was suspected to be a relapse of SLE. Unfortunately, after treatment with high-dose intravenous methylprednisolone, the response was poor with persistent low platelet level. Besides, hemolytic anemia and thrombocytopenia were noted and peripheral blood smear examination also showed fragmented red blood cells, supporting the diagnosis of microangiopathic hemolytic anemia. Moreover, there was severe ADAMTS13 deficiency in the blood, even with 0% of activity. Therefore, the patient was finally diagnosed with thrombotic thrombocytopenic purpura and then received urgent plasmapheresis in combination with high-dose glucocorticoid and of intravenous rituximab treatment. After the treatment, the platelet level increased, lactate dehydrogenase level remarkably decreased, and anemia gradually improved. Taken together, urgent initiation of plasma exchange together with glucocorticoid and rituximab treatment for SLE patient with thrombotic thrombocytopenic purpura could lower the mortality rate.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129845771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
臨床上，妊娠期高血壓併頭痛是產科常見的問題之一，但若演變成子癇前症（Preeclampsia）、子癇症（Eclampsia）及HELLP症候群（HELLP syndrome）包括溶血（Hemolysis, H）、肝酵素升高（Elevated Liver enzymes, EL）和低血小板計數（Low Platelet count, LP），對孕婦及胎兒的影響則非常巨大。本案例是一位31歲妊娠約33+2週的女性個案，因突發性頭痛、腹痛合併少量陰道出血求治，被診斷為子癇前症，隨後併發胎盤早期剝離造成胎兒窘迫，須立即終止妊娠，經緊急剖腹順利產下一名女嬰，隔日追蹤全血球計數，顯示血小板突降，進而追蹤生化血檢查，發現肝功能惡化，所幸經支持療法，血壓控制得宜、肝指數下降及血小板回復正常，病況穩定順利出院。HELLP症候群是子癇前症的併發症大多發生於妊娠期，致死率高，文獻上指出極少數於產後發生，身為臨床第一線的我們，即使個案產後也應該要提高警覺，嚴密的監控血壓與症狀，快速診斷，早期介入治療，並排除其他內科原因，以保護母體安全。 Clinically, gestational hypertension complicated by headaches is common in Obstetrics. However, it may cause severe impacts on pregnant women and fetuses if it evolves into preeclampsia, eclampsia and HELLP syndrome that characterized by hemolysis, elevated liver enzymes, and a low platelet count. The case in this study is a thirty-one-year-old pregnant woman with 33+2 weeks of gestation, who was diagnosed with preeclampsia due to a sudden headache, abdominal pain and a small amount of vaginal bleeding. Subsequent abruptio placenta led to fetal distress so her pregnancy was terminated.A baby girl was successfully delivered by emergency caesarean section. The next day, the complete blood count showed a sudden drop in platelets. A biochemical blood test found that liver function deteriorated. After supportive therapy, blood pressure was well-controlled, liver index decreased and platelets level returned to normal. Eventually the patient recovered and discharged. HELLP syndrome is a complication of preeclampsia that mostly occurs during pregnancy and has a high fatality rate.Postpartum HELLP syndrome is rare. Frontline medical staff should be vigilant even in postpartum period. By close monitoring of blood pressure and related symptoms, early diagnosis and treatment could be prescribed to protect the mother’s safety.
临床上，妊娠期高血压并头痛是产科常见的问题之一，但若演变成子痫前症（Preeclampsia）、子痫症（Eclampsia）及HELLP症候群（HELLP syndrome）包括溶血（Hemolysis, H）、肝酵素升高（Elevated Liver enzymes, EL）和低血小板计数（Low Platelet count, LP），对孕妇及胎儿的影响则非常巨大。本案例是一位31岁妊娠约33+2周的女性个案，因突发性头痛、腹痛合并少量阴道出血求治，被诊断为子痫前症，随后并发胎盘早期剥离造成胎儿窘迫，须立即终止妊娠，经紧急剖腹顺利产下一名女婴，隔日追踪全血球计数，显示血小板突降，进而追踪生化血检查，发现肝功能恶化，所幸经支持疗法，血压控制得宜、肝指数下降及血小板回复正常，病况稳定顺利出院。HELLP症候群是子痫前症的并发症大多发生于妊娠期，致死率高，文献上指出极少数于产后发生，身为临床第一线的我们，即使个案产后也应该要提高警觉，严密的监控血压与症状，快速诊断，早期介入治疗，并排除其他内科原因，以保护母体安全。 Clinically, gestational hypertension complicated by headaches is common in Obstetrics. However, it may cause severe impacts on pregnant women and fetuses if it evolves into preeclampsia, eclampsia and HELLP syndrome that characterized by hemolysis, elevated liver enzymes, and a low platelet count. The case in this study is a thirty-one-year-old pregnant woman with 33+2 weeks of gestation, who was diagnosed with preeclampsia due to a sudden headache, abdominal pain and a small amount of vaginal bleeding. Subsequent abruptio placenta led to fetal distress so her pregnancy was terminated.A baby girl was successfully delivered by emergency caesarean section. The next day, the complete blood count showed a sudden drop in platelets. A biochemical blood test found that liver function deteriorated. After supportive therapy, blood pressure was well-controlled, liver index decreased and platelets level returned to normal. Eventually the patient recovered and discharged. HELLP syndrome is a complication of preeclampsia that mostly occurs during pregnancy and has a high fatality rate.Postpartum HELLP syndrome is rare. Frontline medical staff should be vigilant even in postpartum period. By close monitoring of blood pressure and related symptoms, early diagnosis and treatment could be prescribed to protect the mother’s safety.
{"title":"一位33週孕婦以突發性頭痛為表現，併發產後HELLP症候群","authors":"李庭溱 李庭溱, 周靜玉 Ting-Chen Li, 何渼樺 Ching-Yu Chou, 曾英智 Mei-Hua Ho","doi":"10.53106/2410325x2021120802008","DOIUrl":"https://doi.org/10.53106/2410325x2021120802008","url":null,"abstract":"\u0000 臨床上，妊娠期高血壓併頭痛是產科常見的問題之一，但若演變成子癇前症（Preeclampsia）、子癇症（Eclampsia）及HELLP症候群（HELLP syndrome）包括溶血（Hemolysis, H）、肝酵素升高（Elevated Liver enzymes, EL）和低血小板計數（Low Platelet count, LP），對孕婦及胎兒的影響則非常巨大。本案例是一位31歲妊娠約33+2週的女性個案，因突發性頭痛、腹痛合併少量陰道出血求治，被診斷為子癇前症，隨後併發胎盤早期剝離造成胎兒窘迫，須立即終止妊娠，經緊急剖腹順利產下一名女嬰，隔日追蹤全血球計數，顯示血小板突降，進而追蹤生化血檢查，發現肝功能惡化，所幸經支持療法，血壓控制得宜、肝指數下降及血小板回復正常，病況穩定順利出院。HELLP症候群是子癇前症的併發症大多發生於妊娠期，致死率高，文獻上指出極少數於產後發生，身為臨床第一線的我們，即使個案產後也應該要提高警覺，嚴密的監控血壓與症狀，快速診斷，早期介入治療，並排除其他內科原因，以保護母體安全。\u0000 Clinically, gestational hypertension complicated by headaches is common in Obstetrics. However, it may cause severe impacts on pregnant women and fetuses if it evolves into preeclampsia, eclampsia and HELLP syndrome that characterized by hemolysis, elevated liver enzymes, and a low platelet count. The case in this study is a thirty-one-year-old pregnant woman with 33+2 weeks of gestation, who was diagnosed with preeclampsia due to a sudden headache, abdominal pain and a small amount of vaginal bleeding. Subsequent abruptio placenta led to fetal distress so her pregnancy was terminated.A baby girl was successfully delivered by emergency caesarean section. The next day, the complete blood count showed a sudden drop in platelets. A biochemical blood test found that liver function deteriorated. After supportive therapy, blood pressure was well-controlled, liver index decreased and platelets level returned to normal. Eventually the patient recovered and discharged. HELLP syndrome is a complication of preeclampsia that mostly occurs during pregnancy and has a high fatality rate.Postpartum HELLP syndrome is rare. Frontline medical staff should be vigilant even in postpartum period. By close monitoring of blood pressure and related symptoms, early diagnosis and treatment could be prescribed to protect the mother’s safety.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"70 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114023979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
背景：根據2019年6月1日～6月30日，統計本單位辦理出院等候時間平均每人為247分鐘，導致病人中午 12點後出院比率高達58.7%，高於全院平均值41.6%；新病人皆集中於下午3－ 4點才入住病房比率 高達61.2%，進而衍生諸多抱怨及醫護人員交接班壓力，故引發照護團隊執行專案之動機。 目的： 縮短辦理出院等候時間為96分鐘；提升辦理出院滿意度為4.0分。 解決方案： 分析問題主要導因包括：護理師未能在第一時間知悉出院醫囑及覆核當日出院相關照護耗時、書記因電子支付操作繁瑣，擔心刷卡錯誤、病人不瞭解辦理出院程序、各類文件申請方式宣導不足及繳費及領藥時間長。設立解決辦法為（一）提前告知出院時間及出院前一天完成出院醫囑開立、（二）提早覆核出院計畫、（三）擬定信用卡繳費操作說明、（四）修訂出院流程作業標準、（五）製作申請各類證明文件公告板、（ 六）規劃出院帶藥送至病房、（ 七）推動電子支付繳費。 結果評值：經專案執行後，辦理出院等侯時間247分鐘縮短96分鐘；辦理出院滿意度達由3.72分提升至4.0分，達本專案目的。 結論： 藉由跨單位溝通、協調及共同合作，簡化辦理出院流程，方可降低辦理出院等候時間，進而提升服務品質、病床周轉率及病人安全。 Background: According to the statistics data from June 1st to June 30th, 2019, the average waiting time of discharge from the unit was 247 minutes per person that led to a patient discharge rate of 58.7% after 12 noon, which was higher than the hospital’s average of 41.6%. The rate of new patients who were admitted to the ward at 3-4 pm was as high as 61.2%. This has resulted in many complaints, and generated pressure on the handover of medical staff, which motivated of the authors to implement this project. Purpose: The purpose of this project to reduce the waiting time of discharge to 96 minutes, and to improve the satisfaction level of discharge to 4.0 points. Strategies Procedure: Analyzing of the major causes of the problem, including the causal factors as follows: the nursing staff failed to notice the discharge order and conduct the time-consuming discharging care in the first time, the associate clerks worry about making mistakes when operating the complicated electronic payment procedures, the patient did not familiar with the discharge procedures, and insufficient introduction of various document and application procedures and long time waiting for payment and receiving medicine. The strategies to solve the problem includes (1)inform the nurse in charge about the discharge order in advance and issue doctor’s order of discharge a day before (2)review the discharge plan earlier, (3) prepare the operation instructions of credit card payment (4) revise the standard of operation of the discharge (5) make a bulletin board for demonstrating all related documents (6) directly deliver discharge medicines to the ward, and (7) promote the use of electronic payment. Outcome: The waiting time of discharge from the hospital was reduced to 96 minutes after the implementation of the project; the satisfaction degree of discharge increased from 3.72 points to 4.0 points, achieving the goal of this project. Conclusion: Through cross-unit communication, coordination and cooperation, discharge procedure was simplified to reduce the waiting time for discharge, thereby improving the quality of service, turnover rate of hospital beds, and patient’s safety.
背景：根据2019年6月1日～6月30日，统计本单位办理出院等候时间平均每人为247分钟，导致病人中午 12点后出院比率高达58.7%，高于全院平均值41.6%；新病人皆集中于下午3- 4点才入住病房比率 高达61.2%，进而衍生诸多抱怨及医护人员交接班压力，故引发照护团队执行专案之动机。目的： 缩短办理出院等候时间为96分钟；提升办理出院满意度为4.0分。解决方案： 分析问题主要导因包括：护理师未能在第一时间知悉出院医嘱及覆核当日出院相关照护耗时、书记因电子支付操作繁琐，担心刷卡错误、病人不了解办理出院程序、各类文件申请方式宣导不足及缴费及领药时间长。设立解决办法为（一）提前告知出院时间及出院前一天完成出院医嘱开立、（二）提早覆核出院计划、（三）拟定信用卡缴费操作说明、（四）修订出院流程作业标准、（五）制作申请各类证明文件公告板、（ 六）规划出院带药送至病房、（ 七）推动电子支付缴费。结果评值：经专案执行后，办理出院等侯时间247分钟缩短96分钟；办理出院满意度达由3.72分提升至4.0分，达本专案目的。结论： 借由跨单位沟通、协调及共同合作，简化办理出院流程，方可降低办理出院等候时间，进而提升服务品质、病床周转率及病人安全。 Background: According to the statistics data from June 1st to June 30th, 2019, the average waiting time of discharge from the unit was 247 minutes per person that led to a patient discharge rate of 58.7% after 12 noon, which was higher than the hospital’s average of 41.6%. The rate of new patients who were admitted to the ward at 3-4 pm was as high as 61.2%. This has resulted in many complaints, and generated pressure on the handover of medical staff, which motivated of the authors to implement this project. Purpose: The purpose of this project to reduce the waiting time of discharge to 96 minutes, and to improve the satisfaction level of discharge to 4.0 points. Strategies Procedure: Analyzing of the major causes of the problem, including the causal factors as follows: the nursing staff failed to notice the discharge order and conduct the time-consuming discharging care in the first time, the associate clerks worry about making mistakes when operating the complicated electronic payment procedures, the patient did not familiar with the discharge procedures, and insufficient introduction of various document and application procedures and long time waiting for payment and receiving medicine. The strategies to solve the problem includes (1)inform the nurse in charge about the discharge order in advance and issue doctor’s order of discharge a day before (2)review the discharge plan earlier, (3) prepare the operation instructions of credit card payment (4) revise the standard of operation of the discharge (5) make a bulletin board for demonstrating all related documents (6) directly deliver discharge medicines to the ward, and (7) promote the use of electronic payment.Outcome: The waiting time of discharge from the hospital was reduced to 96 minutes after the implementation of the project; the satisfaction degree of discharge increased from 3.72 points to 4.0 points, achieving the goal of this project.Conclusion: Through cross-unit communication, coordination and cooperation, discharge procedure was simplified to reduce the waiting time for discharge, thereby improving the quality of service, turnover rate of hospital beds, and patient’s safety.
{"title":"「最後一公里」的溫馨，縮短內科病房辦理出院等候時間之專案","authors":"李靜宜 李靜宜, 沈桂鳳 Ching-Yi Li, 李月麗 Kuei-Feng Shen, 李育珮 Yueh-Lih Li, 潘慧娟 Yu-Pei Li","doi":"10.53106/2410325x2021120802006","DOIUrl":"https://doi.org/10.53106/2410325x2021120802006","url":null,"abstract":"\u0000 背景：根據2019年6月1日～6月30日，統計本單位辦理出院等候時間平均每人為247分鐘，導致病人中午 12點後出院比率高達58.7%，高於全院平均值41.6%；新病人皆集中於下午3－ 4點才入住病房比率 高達61.2%，進而衍生諸多抱怨及醫護人員交接班壓力，故引發照護團隊執行專案之動機。\u0000目的： 縮短辦理出院等候時間為96分鐘；提升辦理出院滿意度為4.0分。\u0000解決方案： 分析問題主要導因包括：護理師未能在第一時間知悉出院醫囑及覆核當日出院相關照護耗時、書記因電子支付操作繁瑣，擔心刷卡錯誤、病人不瞭解辦理出院程序、各類文件申請方式宣導不足及繳費及領藥時間長。設立解決辦法為（一）提前告知出院時間及出院前一天完成出院醫囑開立、（二）提早覆核出院計畫、（三）擬定信用卡繳費操作說明、（四）修訂出院流程作業標準、（五）製作申請各類證明文件公告板、（ 六）規劃出院帶藥送至病房、（ 七）推動電子支付繳費。\u0000結果評值：經專案執行後，辦理出院等侯時間247分鐘縮短96分鐘；辦理出院滿意度達由3.72分提升至4.0分，達本專案目的。\u0000結論： 藉由跨單位溝通、協調及共同合作，簡化辦理出院流程，方可降低辦理出院等候時間，進而提升服務品質、病床周轉率及病人安全。\u0000 Background: According to the statistics data from June 1st to June 30th, 2019, the average waiting time of discharge from the unit was 247 minutes per person that led to a patient discharge rate of 58.7% after 12 noon, which was higher than the hospital’s average of 41.6%. The rate of new patients who were admitted to the ward at 3-4 pm was as high as 61.2%. This has resulted in many complaints, and generated pressure on the handover of medical staff, which motivated of the authors to implement this project.\u0000 Purpose: The purpose of this project to reduce the waiting time of discharge to 96 minutes, and to improve the satisfaction level of discharge to 4.0 points.\u0000 Strategies Procedure: Analyzing of the major causes of the problem, including the causal factors as follows: the nursing staff failed to notice the discharge order and conduct the time-consuming discharging care in the first time, the associate clerks worry about making mistakes when operating the complicated electronic payment procedures, the patient did not familiar with the discharge procedures, and insufficient introduction of various document and application procedures and long time waiting for payment and receiving medicine. The strategies to solve the problem includes (1)inform the nurse in charge about the discharge order in advance and issue doctor’s order of discharge a day before (2)review the discharge plan earlier, (3) prepare the operation instructions of credit card payment (4) revise the standard of operation of the discharge (5) make a bulletin board for demonstrating all related documents (6) directly deliver discharge medicines to the ward, and (7) promote the use of electronic payment.\u0000Outcome: The waiting time of discharge from the hospital was reduced to 96 minutes after the implementation of the project; the satisfaction degree of discharge increased from 3.72 points to 4.0 points, achieving the goal of this project.\u0000Conclusion: Through cross-unit communication, coordination and cooperation, discharge procedure was simplified to reduce the waiting time for discharge, thereby improving the quality of service, turnover rate of hospital beds, and patient’s safety.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124056124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
背景： 心導管檢查是診斷心血管疾病及治療最常見的方法，若心導管檢查前的準備時間延長，相對影響急性冠心症（ACS）病人行經皮冠狀動脈（PCI）治療的時效。 目的： 專案實施後，透過跨團隊的方式縮短心導管檢查前準備時間。 解決方案： 藉由調整照胸部X光檢查時機、錄製心導管檢查之衛教影片、調整填寫心導管檢查同意書時機、制定心導管檢查前準備事項查檢表等措施，進而縮短心導管檢查前準備之時間。 結果評值： 經方案改善後，心導管檢查前準備時間由84分49秒縮短為34分24秒。 結論： 統整住院病人檢查流程，不僅可有效縮短護理人員的準備時間，亦可提升專業的醫療品質，本專案透過醫護之間的合作，不但能有效的改善工作效率，更能獲得病人家屬對於醫護的讚許。 Background: Cardiac catheterization is the most common method to diagnose and to treat cardiovascular diseases. The preparation time for cardiac catheterization is crucial especially in performing Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS). Purposes: This project attempts to find the factors that affecting the preparation time before cardiac catheterization through interprofessional collaborative. Methods: By adjusting the time of CXR examination, time for consent signed and video of health case education, the preparation time before cardiac catheterization can be reduced to improve the care quality. Results: After the designed procedure was properly performed, the preparation time before cardiac catheterization was reduced from 84 minutes and 49 seconds down to 34 minutes and 24 seconds by average. Conclusions: By integrating the examination process of the inpatients, this defined procedure in this study significantly reduced the preparation time and effectively improved the care quality of cardiac catheterization. Trough the cooperation between medical and nursing staff, this project not only improve the quality of care but also received appreciations from patients and their families.
背景： 心导管检查是诊断心血管疾病及治疗最常见的方法，若心导管检查前的准备时间延长，相对影响急性冠心症（ACS）病人行经皮冠状动脉（PCI）治疗的时效。目的： 专案实施后，透过跨团队的方式缩短心导管检查前准备时间。解决方案： 借由调整照胸部X光检查时机、录制心导管检查之卫教影片、调整填写心导管检查同意书时机、制定心导管检查前准备事项查检表等措施，进而缩短心导管检查前准备之时间。结果评值： 经方案改善后，心导管检查前准备时间由84分49秒缩短为34分24秒。结论： 统整住院病人检查流程，不仅可有效缩短护理人员的准备时间，亦可提升专业的医疗品质，本专案透过医护之间的合作，不但能有效的改善工作效率，更能获得病人家属对于医护的赞许。 Background: Cardiac catheterization is the most common method to diagnose and to treat cardiovascular diseases. The preparation time for cardiac catheterization is crucial especially in performing Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS).Purposes: This project attempts to find the factors that affecting the preparation time before cardiac catheterization through interprofessional collaborative.Methods: By adjusting the time of CXR examination, time for consent signed and video of health case education, the preparation time before cardiac catheterization can be reduced to improve the care quality.Results: After the designed procedure was properly performed, the preparation time before cardiac catheterization was reduced from 84 minutes and 49 seconds down to 34 minutes and 24 seconds by average.Conclusions: By integrating the examination process of the inpatients, this defined procedure in this study significantly reduced the preparation time and effectively improved the care quality of cardiac catheterization. Trough the cooperation between medical and nursing staff, this project not only improve the quality of care but also received appreciations from patients and their families.
{"title":"縮短心導管檢查前準備時間之改善專案","authors":"蔡雪雅 蔡雪雅, 郭以葶 Hsueh-Ya Hsai, 王仁愛 Yi-Ting Kuo, 詹依華 Jen-Ai Wang, 沈佳安 Yi-Hua Chan, 黃少凡 Chia-An Shen, 蔣慧燕 Shao-Fan Hung, 柯雅芳 Hui-Yen Chiang","doi":"10.53106/2410325x2021120802005","DOIUrl":"https://doi.org/10.53106/2410325x2021120802005","url":null,"abstract":"\u0000 背景： 心導管檢查是診斷心血管疾病及治療最常見的方法，若心導管檢查前的準備時間延長，相對影響急性冠心症（ACS）病人行經皮冠狀動脈（PCI）治療的時效。\u0000目的： 專案實施後，透過跨團隊的方式縮短心導管檢查前準備時間。\u0000解決方案： 藉由調整照胸部X光檢查時機、錄製心導管檢查之衛教影片、調整填寫心導管檢查同意書時機、制定心導管檢查前準備事項查檢表等措施，進而縮短心導管檢查前準備之時間。\u0000結果評值： 經方案改善後，心導管檢查前準備時間由84分49秒縮短為34分24秒。\u0000結論： 統整住院病人檢查流程，不僅可有效縮短護理人員的準備時間，亦可提升專業的醫療品質，本專案透過醫護之間的合作，不但能有效的改善工作效率，更能獲得病人家屬對於醫護的讚許。\u0000 Background: Cardiac catheterization is the most common method to diagnose and to treat cardiovascular diseases. The preparation time for cardiac catheterization is crucial especially in performing Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS).\u0000Purposes: This project attempts to find the factors that affecting the preparation time before cardiac catheterization through interprofessional collaborative.\u0000Methods: By adjusting the time of CXR examination, time for consent signed and video of health case education, the preparation time before cardiac catheterization can be reduced to improve the care quality.\u0000Results: After the designed procedure was properly performed, the preparation time before cardiac catheterization was reduced from 84 minutes and 49 seconds down to 34 minutes and 24 seconds by average.\u0000Conclusions: By integrating the examination process of the inpatients, this defined procedure in this study significantly reduced the preparation time and effectively improved the care quality of cardiac catheterization. Trough the cooperation between medical and nursing staff, this project not only improve the quality of care but also received appreciations from patients and their families.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"2006 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129596712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-01DOI: 10.53106/2410325x2021120802002
謝美玲 謝美玲, 楊政達 Mei-Lin Hsieh, 蔡秀鸞 Jheng-Da Yang
專科護理師（簡稱專師）（Nurse practitioner, NP）是本國唯一具有國家證照之進階護理師，與醫師共同提供病人醫療及執行護理照護業務，須通過筆試及口試才能領取執業執照。專師執行病人照顧須展現的臨床推理能力較無法以紙筆測驗評量，故甄審口試採用客觀結構式臨床考試（Objective structured clinical examination,OSCE）以彌補筆試無法評值出的臨床實作能力。OSCE的口試劇本稱之「活考題」，需由標準化病人（Standardized patient, SP）扮演情境角色，真人演出若缺乏一致性可能影響考生的表現，過去每年約有2-3件考生反應SP演出問題的申訴案件。標準化病人訓練師（Standardized patienttrainer,SPT）是訓練SP表演教案的重要角色，過去大多由資深NP或曾擔任SP的資深救護技術員（Emergency medical technician, EMT）擔任口試劇本訓練的SPT，依舉辦單位設計的流程訓練SP，未有前置之SPT訓練課程。有鑑於SP演出涉及 考生的口試成績表現，演出品質的把關相形重要，本文目的為探討應用劇本訓練模組課程進行SPT訓練後，SPT對課程的學習滿意度及考生申覆案件之改善結果。採用「標準化病人師資訓練課程學習滿意度問卷」，包括「課程教材」、「課室訓練課程」，及「劇本實作訓練」三個構面，以李克氏5分法（1分為「非常不滿意」，5分為「非常滿意」） 進行學習成效評值；申覆SP演出件數由舉辦單位提供。參與訓練的SPT共計21位，資深NP 6位，資深EMT 15位。學習滿意度分析發現口試演出結束後總平均分數高於劇本訓練完成後，其中「劇本實作訓練」達統計顯著差異（p< .05），顯示SPT對訓練模組課程的肯定外，109年甄審口試後首次無考生提出SP演出申覆案件。研究發現訓練模組課程能培育出勝任專師甄審口試劇本訓練的SPT。 Nurse practitioners (NP) are the only advanced nurse practitioners with a national license in Taiwan.NPs work with physicians to provide medical treatment and perform nursing care services. NPs must pass written and oral exams to obtain practicing license. The required clinical reasoning ability is difficult to evaluate by using written tests. Therefore, the objective structured clinical examination (OSCE) is chosen to examine practical and clinical ability of future NPs. OSCE scripts are called “living exam questions” and require standardized patients (SP) to play the role in the determined context. Lack of consistency in SPs’ live-action affects the performance of candidates. In the past, candidates’ appeal due to SP performance was about 2 to 3 times per year. Standardized Patient Trainer (SPT) plays a vital role in SP training. In the past, senior NPs or senior emergency medical technicians (EMT), served as the SPT in oral script training, depending on the organizer. There is no pre-SPT training course in the designed process. The quality of SPs’ performance is important because it affects the candidates’performance in the oral exam. Thus, the purpose of this study is to investigate the improvements of SPT’s learning satisfaction and candidates’ appeal rate after SPTs training program adopting the script training module course. A total of 21 SPTs participated in the training program, including 6 senior NPs and 15 senior EMTs. The study adopted the “Learning satisfaction questionnaire of standardized patient trainer training course, (LSQSPTTC), “including three domains of “curriculum materials,”“lesson training,” and “script practice training.” Also, use the Likert 5-point scale (1-very dissatisfied and 5-very satisfied) to evaluate the learning effectiveness. Furthermore, the number of incidents of candidates’ appeal due to SP performance was provided by the examination organizer. The learning satisfaction after the oral exams is higher than the completion of the script training. The domain of “script practice training” had a statistically significant difference (p < 0.05), indicating that SPTs satisfied with the training module courses. F
专科护理师（简称专师）（Nurse practitioner, NP）是本国唯一具有国家证照之进阶护理师，与医师共同提供病人医疗及执行护理照护业务，须通过笔试及口试才能领取执业执照。专师执行病人照顾须展现的临床推理能力较无法以纸笔测验评量，故甄审口试采用客观结构式临床考试（Objective structured clinical examination,OSCE）以弥补笔试无法评值出的临床实作能力。OSCE的口试剧本称之「活考题」，需由标准化病人（Standardized patient, SP）扮演情境角色，真人演出若缺乏一致性可能影响考生的表现，过去每年约有2-3件考生反应SP演出问题的申诉案件。标准化病人训练师（Standardized patienttrainer,SPT）是训练SP表演教案的重要角色，过去大多由资深NP或曾担任SP的资深救护技术员（Emergency medical technician, EMT）担任口试剧本训练的SPT，依举办单位设计的流程训练SP，未有前置之SPT训练课程。有鉴于SP演出涉及 考生的口试成绩表现，演出品质的把关相形重要，本文目的为探讨应用剧本训练模组课程进行SPT训练后，SPT对课程的学习满意度及考生申复案件之改善结果。采用「标准化病人师资训练课程学习满意度问卷」，包括「课程教材」、「课室训练课程」，及「剧本实作训练」三个构面，以李克氏5分法（1分为「非常不满意」，5分为「非常满意」） 进行学习成效评值；申复SP演出件数由举办单位提供。参与训练的SPT共计21位，资深NP 6位，资深EMT 15位。学习满意度分析发现口试演出结束后总平均分数高于剧本训练完成后，其中「剧本实作训练」达统计显著差异（p< .05），显示SPT对训练模组课程的肯定外，109年甄审口试后首次无考生提出SP演出申复案件。研究发现训练模组课程能培育出胜任专师甄审口试剧本训练的SPT。 Nurse practitioners (NP) are the only advanced nurse practitioners with a national license in Taiwan.NPs work with physicians to provide medical treatment and perform nursing care services. NPs must pass written and oral exams to obtain practicing license. The required clinical reasoning ability is difficult to evaluate by using written tests. Therefore, the objective structured clinical examination (OSCE) is chosen to examine practical and clinical ability of future NPs. OSCE scripts are called “living exam questions” and require standardized patients (SP) to play the role in the determined context. Lack of consistency in SPs’ live-action affects the performance of candidates. In the past, candidates’ appeal due to SP performance was about 2 to 3 times per year. Standardized Patient Trainer (SPT) plays a vital role in SP training. In the past, senior NPs or senior emergency medical technicians (EMT), served as the SPT in oral script training, depending on the organizer. There is no pre-SPT training course in the designed process. The quality of SPs’ performance is important because it affects the candidates’performance in the oral exam. Thus, the purpose of this study is to investigate the improvements of SPT’s learning satisfaction and candidates’ appeal rate after SPTs training program adopting the script training module course. A total of 21 SPTs participated in the training program, including 6 senior NPs and 15 senior EMTs. The study adopted the “Learning satisfaction questionnaire of standardized patient trainer training course, (LSQSPTTC), “including three domains of “curriculum materials,”“lesson training,” and “script practice training.” Also, use the Likert 5-point scale (1-very dissatisfied and 5-very satisfied) to evaluate the learning effectiveness. Furthermore, the number of incidents of candidates’ appeal due to SP performance was provided by the examination organizer. The learning satisfaction after the oral exams is higher than the completion of the script training. The domain of “script practice training” had a statistically significant difference (p < 0.05), indicating that SPTs satisfied with the training module courses. Furt
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Pub Date : 2021-12-01DOI: 10.53106/2410325x2021120802007
簡麗芬 簡麗芬, 黃詠嵩 Li-Fen Chien, 羅健寧 Yung-Sung Huang
抗NMDA（N-methyl-D-aspartate）受體腦炎是當人體自身免疫系統產生的抗體攻擊大腦中的NMDA型谷氨酸受體所導致的自體免疫腦炎。發病初期會出現精神症狀，常沒有神經影像學，腦波或腦脊髓液檢查的異常。它很容易被誤診為原發性精神疾病或其他疾病，像是抗精神病藥物惡性症候群（Neuroleptic maligmant syndrome,NMS）、病毒性腦炎、惡性緊張症、藥物濫用、裝病等。抗NMDA受體腦炎症狀與NMS幾乎完全相似不容易被鑑別診斷。自2007年開始因免疫醫學的進步，才終於可以被明確診斷，在此之前有許多病人因為沒有被診斷出抗NMDA受體腦炎而終身被當成精神病人。本案例詳述一位19歲年輕女性出現急性精神異常症狀，自發病、治療、到確診為抗NMDA受體腦炎的經過，並探討疾病的經過、治療的反應及診斷的困難。 Anti N-methyl-D-aspartate antibody encephalitis (Anti-NMDA antibody encephalitis) develops when such antibody binds and damages NMDA receptors in the brain. Psychiatric symptoms and signs,such as hallucination, acute psychosis and delusional state, are often found as early clinical presentations,rather than brain lesion that can be found on neuroimaging. The CSF and EEG studies are often normal, thus such cases are easily misdiagnosed as acute psychosis, neuroleptic malignant syndrome (NMS), viral encephalitis, substance abuse, or malingering. In fact, the symptoms and signs of anti-NMDA antibody encephalitis and NMS are almost identical, making it especially difficult to diagnose. From Since 2007, thanks to the advances of Immunology, such autoimmune encephalitis is now able to be diagnosed accurately. In the past, lots of victims were treated as psychotics when anti-NMDA antibody was not able to be detected. In this case report, we illustrated the clinical presentation, disease progress, responses to treatment, and how the final diagnosis of anti-NMDA encephalitis was made on a 19 years old female who developed acute psychosis.
抗NMDA（N-methyl-D-aspartate）受体脑炎是当人体自身免疫系统产生的抗体攻击大脑中的NMDA型谷氨酸受体所导致的自体免疫脑炎。发病初期会出现精神症状，常没有神经影像学，脑波或脑脊髓液检查的异常。它很容易被误诊为原发性精神疾病或其他疾病，像是抗精神病药物恶性症候群（Neuroleptic maligmant syndrome,NMS）、病毒性脑炎、恶性紧张症、药物滥用、装病等。抗NMDA受体脑炎症状与NMS几乎完全相似不容易被鉴别诊断。自2007年开始因免疫医学的进步，才终于可以被明确诊断，在此之前有许多病人因为没有被诊断出抗NMDA受体脑炎而终身被当成精神病人。本案例详述一位19岁年轻女性出现急性精神异常症状，自发病、治疗、到确诊为抗NMDA受体脑炎的经过，并探讨疾病的经过、治疗的反应及诊断的困难。 Anti N-methyl-D-aspartate antibody encephalitis (Anti-NMDA antibody encephalitis) develops when such antibody binds and damages NMDA receptors in the brain. Psychiatric symptoms and signs,such as hallucination, acute psychosis and delusional state, are often found as early clinical presentations,rather than brain lesion that can be found on neuroimaging. The CSF and EEG studies are often normal, thus such cases are easily misdiagnosed as acute psychosis, neuroleptic malignant syndrome (NMS), viral encephalitis, substance abuse, or malingering. In fact, the symptoms and signs of anti-NMDA antibody encephalitis and NMS are almost identical, making it especially difficult to diagnose. From Since 2007, thanks to the advances of Immunology, such autoimmune encephalitis is now able to be diagnosed accurately. In the past, lots of victims were treated as psychotics when anti-NMDA antibody was not able to be detected. In this case report, we illustrated the clinical presentation, disease progress, responses to treatment, and how the final diagnosis of anti-NMDA encephalitis was made on a 19 years old female who developed acute psychosis.
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背景：體重流失是造成新生兒高膽紅素血症重要因素之一，自母嬰親善醫院提倡母奶哺餵，我們觀察到新 生兒因高膽紅素血症需再入院照光治療比例有增加趨勢，因此，了解高膽紅素血症新生兒體重流失 的相關因素極其重要 目的：探討高膽紅素血症新生兒體重流失之相關因素。 方法：研究收集2015年1月1日至2019年11月30日因高膽紅素血症再入院足月新生兒共285位進行回溯性病歷研究，以描述性統計分析、獨立樣本t檢定、單因子變異數分析、Mann-Whitney U及複迴歸進行資料分析。 結果： 新生兒高膽紅素血症再入院平均體重流失率為4.47% ± 4.22%。複迴歸分析結果顯示新生兒出生體重、再入院體重、總血清膽紅素值及純母乳哺餵等為新生兒體重流失率的預測因子。 結論/實務運用：研究證實新生兒出生體重、再入院體重及總血清膽紅素值與體重流失率有相關性。臨床醫護 人員應於新生兒首次出院前確認是否有體重過度流失現象，早期檢測血清膽紅素值，教導父母出院後監測新生兒體重的變化，以避免新生兒因過度體重流失而導致高膽紅素血症再入院。 Background: Weight loss is one of major the factors in neonatal hyperbilirubinemia. Since Baby-Friendly initiatives promoted breastfeeding, we have observed an increase of neonates who need to be readmitted to the hospital for phototherapy due to hyperbilirubinemia. Therefore, it is very important to understand the related factors of weight loss in newborns with hyperbilirubinemia.Purpose: To explore the relationships between neonatal hyperbilirubinemia and body weight loss. Methods: This retrospective study enrolled 285 full-term newborns who were readmitted within one month after birth due to hyperbilirubinemia during 1st January 2015 ad 30th November 2019. Data were analyzed by independent t-test, analysis of variance, Mann-Whitney U, and multiple regression. Results: The average weight loss percentage of neonatal hyperbilirubinemia was 4.47% ± 4.22%. The results of multiple regression analysis showed that neonatal birth weight, readmission weight, total serum bilirubin and exclusive breastfeeding were the predictors of neonatal weight loss percentage. Conclusions/Implications for Practice: The study confirmed that the birth weight, readmission weight and total serum bilirubin were correlated with weight loss percentage. Clinical healthcare providers should confirm whether there is excessive weight loss before of before the infant is discharged from the hospital. Early detection of serum bilirubin and teach the parents to monitor the change of the neonatal weight after discharged could avoid the neonatal hyperbilirubinemia due to excessive weight loss.
背景：体重流失是造成新生儿高胆红素血症重要因素之一，自母婴亲善医院提倡母奶哺喂，我们观察到新 生儿因高胆红素血症需再入院照光治疗比例有增加趋势，因此，了解高胆红素血症新生儿体重流失 的相关因素极其重要目的：探讨高胆红素血症新生儿体重流失之相关因素。方法：研究收集2015年1月1日至2019年11月30日因高胆红素血症再入院足月新生儿共285位进行回溯性病历研究，以描述性统计分析、独立样本t检定、单因子变异数分析、Mann-Whitney U及复回归进行资料分析。结果： 新生儿高胆红素血症再入院平均体重流失率为4.47% ± 4.22%。复回归分析结果显示新生儿出生体重、再入院体重、总血清胆红素值及纯母乳哺喂等为新生儿体重流失率的预测因子。 结论/实务运用：研究证实新生儿出生体重、再入院体重及总血清胆红素值与体重流失率有相关性。临床医护 人员应于新生儿首次出院前确认是否有体重过度流失现象，早期检测血清胆红素值，教导父母出院后监测新生儿体重的变化，以避免新生儿因过度体重流失而导致高胆红素血症再入院。 Background: Weight loss is one of major the factors in neonatal hyperbilirubinemia. Since Baby-Friendly initiatives promoted breastfeeding, we have observed an increase of neonates who need to be readmitted to the hospital for phototherapy due to hyperbilirubinemia. Therefore, it is very important to understand the related factors of weight loss in newborns with hyperbilirubinemia.Purpose: To explore the relationships between neonatal hyperbilirubinemia and body weight loss. Methods: This retrospective study enrolled 285 full-term newborns who were readmitted within one month after birth due to hyperbilirubinemia during 1st January 2015 ad 30th November 2019. Data were analyzed by independent t-test, analysis of variance, Mann-Whitney U, and multiple regression.Results: The average weight loss percentage of neonatal hyperbilirubinemia was 4.47% ± 4.22%. The results of multiple regression analysis showed that neonatal birth weight, readmission weight, total serum bilirubin and exclusive breastfeeding were the predictors of neonatal weight loss percentage.Conclusions/Implications for Practice: The study confirmed that the birth weight, readmission weight and total serum bilirubin were correlated with weight loss percentage. Clinical healthcare providers should confirm whether there is excessive weight loss before of before the infant is discharged from the hospital. Early detection of serum bilirubin and teach the parents to monitor the change of the neonatal weight after discharged could avoid the neonatal hyperbilirubinemia due to excessive weight loss.
{"title":"高膽紅素血症新生兒體重流失之相關因素探討","authors":"邱秀玲 邱秀玲, 卓德松 Hsiu-Ling Chiu, 蕭思美 Teck-Siang Tok, 楊燦 Szu-Mei Hsiao","doi":"10.53106/2410325x2021120802004","DOIUrl":"https://doi.org/10.53106/2410325x2021120802004","url":null,"abstract":"\u0000 背景：體重流失是造成新生兒高膽紅素血症重要因素之一，自母嬰親善醫院提倡母奶哺餵，我們觀察到新 生兒因高膽紅素血症需再入院照光治療比例有增加趨勢，因此，了解高膽紅素血症新生兒體重流失 的相關因素極其重要\u0000目的：探討高膽紅素血症新生兒體重流失之相關因素。\u0000方法：研究收集2015年1月1日至2019年11月30日因高膽紅素血症再入院足月新生兒共285位進行回溯性病歷研究，以描述性統計分析、獨立樣本t檢定、單因子變異數分析、Mann-Whitney U及複迴歸進行資料分析。\u0000結果： 新生兒高膽紅素血症再入院平均體重流失率為4.47% ± 4.22%。複迴歸分析結果顯示新生兒出生體重、再入院體重、總血清膽紅素值及純母乳哺餵等為新生兒體重流失率的預測因子。\u0000 結論/實務運用：研究證實新生兒出生體重、再入院體重及總血清膽紅素值與體重流失率有相關性。臨床醫護 人員應於新生兒首次出院前確認是否有體重過度流失現象，早期檢測血清膽紅素值，教導父母出院後監測新生兒體重的變化，以避免新生兒因過度體重流失而導致高膽紅素血症再入院。\u0000 Background: Weight loss is one of major the factors in neonatal hyperbilirubinemia. Since Baby-Friendly initiatives promoted breastfeeding, we have observed an increase of neonates who need to be readmitted to the hospital for phototherapy due to hyperbilirubinemia. Therefore, it is very important to understand the related factors of weight loss in newborns with hyperbilirubinemia.Purpose: To explore the relationships between neonatal hyperbilirubinemia and body weight loss.\u0000 Methods: This retrospective study enrolled 285 full-term newborns who were readmitted within one month after birth due to hyperbilirubinemia during 1st January 2015 ad 30th November 2019. Data were analyzed by independent t-test, analysis of variance, Mann-Whitney U, and multiple regression.\u0000Results: The average weight loss percentage of neonatal hyperbilirubinemia was 4.47% ± 4.22%. The results of multiple regression analysis showed that neonatal birth weight, readmission weight, total serum bilirubin and exclusive breastfeeding were the predictors of neonatal weight loss percentage.\u0000Conclusions/Implications for Practice: The study confirmed that the birth weight, readmission weight and total serum bilirubin were correlated with weight loss percentage. Clinical healthcare providers should confirm whether there is excessive weight loss before of before the infant is discharged from the hospital. Early detection of serum bilirubin and teach the parents to monitor the change of the neonatal weight after discharged could avoid the neonatal hyperbilirubinemia due to excessive weight loss.\u0000 \u0000","PeriodicalId":177436,"journal":{"name":"台灣專科護理師學刊","volume":"176 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124362149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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