Implementation and evaluation of a clinical path for radical prostatectomy ―with special reference to postoperative urinary disturbance―

摘要

我々は, 過去に平均的な経過を った前立腺全摘術後の患者の術前・術後処置項目を抽出して, 平均的な処置を施行した日数を割り出し, 患者用クリニカルパス第１版を作成した. この作成と平行して, クリニカルパスを使用しない状態での患者７名にアンケート調査を行い, 前立腺全摘術後の患者の不満や要望を確認することにした. その結果,従来のパンフレットや小冊子を用いた説明だけでは, 尿失禁の説明, 尿取りパッドの準備, 骨盤底筋体操の説明, 排尿日誌の使い方の説明など, 術後の排尿障害について, ｢理解できなかった｣, ｢説明がなかった｣との不満が聞かれた. そこで, 排尿障害に関連した説明項目をクリニカルパスに追記し, かつ朱字で記載して, 患者用クリニカルパス第２版を作成した. これを臨床に導入後, ５名の患者にアンケート調査を行いその有用性を検討した. ５名とも排尿障害に関連した説明について不満はなく, クリニカルパスの有用性が確認できた.We reviewed our experience with radical prostatectomy performed using standardized technique and a clinical path (1st version) was prepared. Before implementation of the clinical path, seven patients were interviewed to ascertain the usefulness of the clinical path. Several patients complained that they did notunderstand the nurse s explanation of using a pamphlet with respect to the postoperative urinary disturbance such as urine leak, urinary retention, pelvic floor exercise etc.Accordingly the abovementioned items were added, and a second version clinical path was developed and implemented clinically. Five patients were interviewed to elucidate the usefulness of the clinical path.There was no dissatisfaction with regard to the nurse s explanation of postoperative urinary disturbance using a clinical path (2nd version).