The Effect of Systematic Nursing Intervention for the Caregiver Taking Care of a Child with an Ostomy

目的：發展並使用「兒童腸造口照護手冊」，以了解系統護理指導對接受腸造口手術 兒童主要照顧者的影響。病人及方法：本研究方法採調查法，以某醫學中心小兒科病 房接受腸造口手術病人為對象，使用「兒童腸造口照護手冊」作為指導依據，在指導 前後以「照顯者對腸造口照護需求」問卷作為收集，共得有效樣本數15位，前後問卷 各15份。結果：在系統性護理指導前，有35.7%的照顧者看到「腸造口」會害怕；73. 3%的照顧者表示有強照的學習意願。照顧者想知道有關腸造口照護的相關資料包括： 「造口周圍皮膚清潔與觀察」、「造口認識」、「如何更換人工肛門袋」、「大便性 狀的評估」、「飲食準備」、「日常生活注意事項」及「造口用物何處購買」。經由 系統護理指導後，照顧者在認知方面的平均分數都提高，尤其在「了解如何觀察造口 皮膚顏色及性狀」、「知道如何準備及更換用物」、「知道如何判斷小孩大便的性狀 是否正常」、「知道有關手術後日常生活應注意事項」等四方面，以無母數統計分析 (Wilcoxon test) 檢驗其平均分數發現有顯著差異；100%的照顧者都瞭解造口的位置 、名稱及功能(之前為66.7%)；91.7%的人素示系統性護理指導對居家的幫助很大；91 .7%的人都知道何處購買用物；83.3%的人感受到護理人員給予很多的協助，但是照顧 者感覺照顧有造口的病童比一般生病小孩較辛苦的，指導前後百分比差異不大，分析 其原因，應該與照顧責任沒有他人可以共同分擔有關，而與護理指導無關。結論：系 統性護理指導有其成效但多數的照顧者認為仍有繼續進行的必要，這一點可以提供臨 床護理人員在照顧有腸造口的兒童時一個很重要的依據與建議，共同為提昇兒童腸造 口護理品質而努力。(慈濟醫學 2000;12:131-139) Objective: This study was to understand the effects of systematic nursing intervention for a caregiver taking care of her child undergoing ostomy surgery for the first time. Patients and Methods: A survey was adopted in this research. A “ Handbook of Care of Children with Ostomies “ was used as the guidance for nursing intervention. A structured questionnaire, “The Care Needs of Children with Ostomies for Caregivers,” was used to collect data before and after systematic nursing intervention. Fifteen caregivers agreed to be involved in this study and completed it effectively. Results: About half of the subjects had heard of an “ostomy” before their children got sick. There were 73.3% of subjects strongly eager to know how to take care of their children, including:” skin protection and observation skills”, ”knowing the function of ostomy”, ”changing the ostomy appliance”, “assessment of fecal elimination”, “diet preparation”, ”precautions for daily activities” and where to buy related materials”. The average score for knowledge about ostomy care was higher after systematic nursing instruction. Using the Wilcoxon test, significant difference was shown for “skin protection and observation skills”, “changing the ostomy appliance”, “assessment of fecal elimination” and “precautions for daily activities”. Between before and after systematic nursing intervention . After nursing intervention, 91.7% of the subjects knew where to buy related materials. Conclusions: Most of the caregivers felt it was more difficult to take care of a child with an ostomy than to take care of a generally sick child. Of the subjects, 83.3% appreciated the help and intervention from nurses, and 91.7% of them thought the systematic nursing intervention helpful for them in doing home care. (Tzu Chi Med J 2000; 12:131-139)