第六章 結論與建議
第二節 建議
根據研究過程所遭遇之問題以及研究結果，以下就護理臨床照護、護理教育以及護 理研究等面向提出建議：
(一) 臨床護理照護
根據研究結果可知增加手術後下床活動的各面向，可改善病人手術後之復原以及症 狀困擾。但臨床上常面臨個案手術後第一天~第二天因疼痛、嗜睡等症狀而不願下床。
臨床護理人員可經由觀察病人症狀，與醫師討論適當的藥物使用以改善疼痛，並在手術 後盡可能改善病人夜間睡眠品質，以促進日間下床活動之意願。年長病人手術後常因虛 弱無力，為避免跌倒發生，臨床上大多不刻意督促病人下床活動。導致老年病人手術後 首次下床活動時間多為術後第二天~第三天，因臥床時間較長，首次下床時亦無法有足 夠肌力適應步行，因此對於此病人族群，手術後若病人無法配合下床步行，可指導病人 於床上進行下肢運動，並鼓勵坐高、床旁站立及踏步，以促進後續下床活動能力。
(二) 護理教育
因過去研究皆未提及手術後下床活動對於病人手術後復原以及症狀改善的明確影 響為何，因此在施行臨床照護時，常無法確切指導病人下床步行的優點為何，根據此研 究結果，或可提供臨床護理人員證據以支持施行此護理措施的必要性，進而改善病人手 術後之生活品質。
(三) 護理研究
此研究需密切填寫症狀量表以及活動日誌取得資料，因研究中老年人口較多，在量 表分數填答部分常有評分困難情形或對症狀認知了解度低（如食欲低、注意力不集中等 症狀），當有回答困難時常以「一點點」、「兩三分啦」做為回應，且相較於年齡層較低 的病人，症狀嚴重度填答分數普遍偏低，可能導致資料收集受到影響，建議後續研究者 或可在量表中增加質性資料的收集以確認症狀對於病人影響程度為何，是否可對應至症 狀嚴重度之分數。此外，原先預計使用計步器做為下床步行距離之資料收集工具，但因 傳統計步器在手術後步行速度較慢的病人身上有明顯測量誤差，因此改以病人紀錄實際
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行走路徑，換算為步行距離做為資料代替。建議後續進行類似研究者，可考慮採用目前 市面上常見之運動手環，或可得到較高之資料準確度，且在資料收集上也較為容易。
(四) 研究推論性
因研究人力及物力限制，本研究僅於北部醫學中心大腸直腸外科病房收案，該院 病人年齡層普遍較高，病人基本屬性狀況較複雜，或許無法推論至其他地區醫療院所 之病人。建議可擴大研究範圍，更可確認此研究結果是否足以支持多數病人之照護需 求。
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