手術室護理學 課程介紹與手術室基本概念 長庚科技大學 護理系 許翠華

單元目標 本單元結束後，同學能 了解手術室護理學課程規範 明白手術室護理實務之發展 說明手術室工作小組團隊概念 分析手術全期護理師在護理專業核心素養之培育 批判手術全期護理師與技術員/醫師助理之不同

課程介紹 在學習後，學生能 以學理及技術並重的概念，對手術室護理能有更進一步的認識， 運用護理過程提供手術病人安全環境及完整的手術全期護理

教學目標 1.能瞭解手術室護理概念、手術室常用的器械及工作流程 2.能認識並執行手術室全期護理 3.能瞭解麻醉的種類、麻醉合併症 4.能正確說出注意手術病患安全之重要性 5.能確實執行手術病患安全之措施及預防合併症

評分方式 1.校外參訪心得報告15% 2.技術考20%、器械跑台考試20% 3.期末考35% 4.課程參與度10%(出席狀況、課室參與)

參考文獻 1.蔡麗絲(2002)．當代內外科護理（上冊）．於許淑蓮總校閱．手術病人之護理(pp.427-511)．台北：華杏。 3.楊月嬌(2000)．手術室護理標準與建議性措施．台北：中華民國護理學會。 4.戴宣(2008)．解剖生理．於王錫崗總校閱．消化系統(pp.457-502)．台北：華杏。 5.黃玉琪、呂國昀(2008)．解剖生理．於王錫崗總校閱．秘尿系統(pp.537-558)．台北：華杏。 6.伍燕鈴、吳秋燕、張玉珠、劉棻(2009)．手術室護理(二版)．台北：華杏。 7.Rothrock, J. & McEwen, D. (2011). Alexander’s Care of the Patient in Surgery (14th eds.). Missouri: Elsevier. 8.Wu, L. M., Xu, X., & Zheng, S. S. (2005). Hepatitis B virus reinfection after liver transplantation: related risk factors and perspective. Hepatobiliary and Pancreatic Disease International, 4 (4), 502-508.

其他事項 上課時間基本上為星期三8.40~11.30，請根據教學進度表所列時間出席 請各班選出一位小老師負責與老師聯絡及點名 所有講義請由e-Campus下載，也請隨時注意相關通告 手術室參訪時間另行公布

老師聯絡方式 請參考老師的office hours時段，先與老師預約時間 老師姓名 分機 e-mail 許翠華 2615 thhsu@gw.cgust.edu.tw

Theatre vs. Operating Room

外科學之歷史 西元4000年埃及楔形文字對人體器官之描述 16世紀 1850 Pare執行節之後動脈結紮 Harvey解剖心血管，證明循環系統之基本功能 Willis進行腦部解剖 1850 Paster 微生物、病毒及免疫學之父 Lister 發展外科無菌技術 Billroth發展進階外科手術步驟(胃切除) Halsted發展精密傷口縫合

1950 Cooley 美國第一例心臟移植 1980內視鏡手術逐漸變主流 1990電腦輔助手術

現代外科學 「外科」指一般無法以內科方式幫助病患解決醫療問題的步驟 過程通常包括打開身體以移除修復或置換身體某部分 治療性功能，如修復損傷的組織 矯正性功能，如矯正先天性其行與缺陷。

Surgical classification Diagnostic – Eg. Biopsy or explorative laparotomy Curative – Eg. Excision of a tumor or inflamed appendix Reparative – Eg. Multiple Wound Repair Reconstructive / Cosmetic – Eg. Mammoplasty or facelift Palliative – Eg. To relieve pain, a PEG tube is inserted to compensate for dysphagia

The history of ORN can trace its origin back to 1875, when the first lecture was given to a group of nurses at Johns Hopkins University in Baltimore, USA. 1911發表之Practical Nursing期中一個章節描述"Preparation for operating in a private house" 1959Association of Operating Room Nursing (AORN)成立 1970s the emphasis on Operating Room Nursing include pre-operative, intra-operative and post-operative care, the term “Perioperative Nursing” has gradually gained acceptance

手術室工作小組團隊概念 「團隊」指二人(含)以上組成之團體，為共同目的而彼此合作，以圓滿達成目標 手術室團隊 無菌團隊 非無菌團隊 接待、等待、進行、完成

Overview of perioperative nursing practice (1/2) is the nursing care provided to patients before, during, and after surgical and invasive procedures “operating room nursing” care of the patients in the immediate preparative, intraoperative and postopertative phases of the surgical experience Practice behind the double door

Overview of perioperative nursing practice (2/2) the OR nurse provides a continuity of care throughout the perioperative period, using scientific and behavioral practices with the eventual goal of meeting the individual needs of the patient undergoing surgical intervention. This process is dynamic and continuous, and requires constant reevaluation of individual nursing practice in the operating room.

What a perioperative nurse do? delivers the comprehensive patient care using the framework of nursing process collaborates with other healthcare professionals provide safe environment for the patient

The competences Understanding the rationale for certain activities and interventions Knowledge of how and when to implement these activities and interventions Skills to evaluate safety, cost-effectiveness, and outcome of these activities and interventions

技術員 vs. 手術全期護理師 護理專業核心素養 心態 基礎生物醫學科學能力 ㄧ般臨床技能 批判性思考 溝通與合作 關愛 倫理 克盡職責 終身學習 心態

「手術室環境設計」 單元學習重點與參考資料 思考問題 手術常見的意外事件有哪些？ 身為手術全期護理師，該如何維護手術室環境安全？ 建議閱讀 吳秋燕 (2009)．手術室環境設計及安全‧於伍燕鈴、吳秋燕、張玉珠、劉棻着(二版)手術室護理(p.31-66) ．台北：華杏。 Lucha, P.A., Wallace, D., Pasque, C., Brichhouse, N., Olsen, D., & Styk, S. et al. (2010). Surgical would mobidity in an austere surgivcal environment. Minitary Medicine, 175(5), 357-361. Alfredsdottir, H., & Bjornsdottir, K. (2008). Nurse and patient safety in the operating room. Ann Surg, 245(2), 173-175. Murphy, E. K. (2011). Patient safety and risk management. In J. Rothrock & D. McEwen (14th eds.). Alexander’s Care of the Patient in Surgery (p.18-47). Missouri: Elsevier. Patton, R. M. (2011). Workplace issues and staff safety. In J. Rothrock & D. McEwen (14th eds.). Alexander’s Care of the Patient in Surgery (p.1258-1282). Missouri: Elsevier.

Preparation for operating in a private house There will be needed a narrow kitchen table for the operating table (if it is not sufficiently long, place two table together and tie their legs together firmly to stop them slipping apart)., three small table, and a chair…… Practical Nursing, 1911, p.33