背景：病人在醫院的意外事件中，比率最高的是跌倒事件。腫瘤科病人因疾病接受化學治療和使用藥物，導致身體虛弱等問題增加了跌倒的危險性。
目的：探討腫瘤科病人參與式護理指導方案對預防跌倒知識、自我效能及對跌倒事件發生率的影響。
方法：本研究採類實驗研究法，以中部某醫學中心血液腫瘤科住院病人為研究對象，採立意取樣，收案60名。研究工具為自擬的預防跌倒知識與自我效能問卷，病患入院後即評估其預防跌倒的知識和效能，再介入一個參與式護理指導方案，3天後再以問卷方式評量其知識和效能。收案介入期間後病房的跌倒事件發生率與介入前一年同期的跌倒事件發生率比較其介入成效。
結果：腫瘤科病人對預防跌倒的知識平均答對率70.7%，預防跌倒自我效能平均得分為46.05分(SD=11.58)。在預防跌倒的知識與跌倒危險因子中的意識狀態，自覺意識清楚者在預防跌倒知識高於自覺意識不清楚者，且達統計上顯著差異(p<.05)。預防跌倒自我效能與有視力障礙、行動能力障礙、排泄障礙的效能高於沒有視力障礙、行動不便、排泄障礙者，達統計顯著的差異。參與式護理指導方案介入後，對預防跌倒知識答對率增加為88.8%，達統計上顯著的差異(p<.001)；預防跌倒的自我效能增加為48.27(SD=10.72)，與前測比較達統計上顯著差異(p<.05)。介入方案後，增加預防跌倒知識(p<.001)，及增加自我效能(p<.05)，皆達統計上顯著差異。介入方案後，腫瘤科病房跌倒事件發生率由0.118%下降為0.039%，達統計上的差異。
結論與建議：腫瘤科病人發生跌倒之危險性高，藉由參與式的護理指導，可提升病患對住院預防跌倒知識及預防跌倒的關注程度，降低跌倒事件的發生率。研究結果可作為臨床護理實務參考，教育病人對住院時期可能導致跌倒的知識與活動，及增加預防跌倒的關注程度，維護病人住院安全及照護品質。
Background: Falls are known to be one of the most common in patient adverse events. The patients with cancer have multiple risk factors for fall, such as chemotherapy, polypharmacy, cancer-related fatigue, and weakness.
Purpose：The purpose of study is to explore the knowledge and self-efficacy of fall prevention and fall incidence rate in oncology patients.
Methods：The study is a quasi-experimental design. A total of 60 participants were recruited. Data were collected by purposive sampling at oncology ward of a medical center in Taichung. The measurement is a self developed questionnaire for knowledge and self-efficacy of fall prevention. Patient’s fall prevention knowledge and self-efficacy was conducted when patients admitted (pretest) and at the third day in hospitalized (posttest). The implementation was a participatory program on fall prevention. The fall incidence rate of oncology patient in the intervention period was compared with the rate in same period at previous year.
Results：The result revealed that mean score of knowledge of fall prevention was 70.7% and self-efficacy was 46.05 (SD=11.58). The patients self-awareness with consciousness that knowledge of fall prevention is higher than unconscious (p<.05). The self-efficacy of fall prevention with visual impairment, gait and balance problems, diarrhea and urinary frequency was higher than those who did not. The Participatory programs intervention has increased the knowledge of fall prevention (p<.001) and self-efficacy of fall prevention (p<.05) The fall incidence rate was 0.118% decreased to 0.039% with a statistics significant.
Conclusion: Oncology patients have a high risk of falls. Through the participatory programs on fall prevention implementation, the knowledge and self-efficacy of fall prevention are increased, and fall incidence rate are decreased. The result can be the reference for clinical nursing. Patient education about knowledge of prevention fall and possible fall activities would increase patients’ awareness of fall prevention, promoting patient safely and care quality.
