加護病房護理人員對預防呼吸器相關肺炎的知識、態度與行為之相關性探討

本研究目的為探討加護病房護理人員對預防呼吸器相關肺炎的知識、態度與行為之相關性。研究方法採橫斷式研究，於台南市一所區域教學醫院為收案場所，以方便取樣方式，選取成人加護病房及亞急性呼吸照護病房之護理人員為收案對象，共計發出150份問卷，回收142份問卷，回收率94.6%，扣除填寫未完整問卷後，有效問卷共有133份。研究工具包括自擬結構式問卷，內容含人口學屬性、預防呼吸器相關肺炎知識量表、態度量表，以及手部衛生、抬高床頭及口腔護理等擬行為過程觀察記錄法，於102年09月16日至102年09月30日為期兩週，進行臨床行為觀察，資料以SPSS 19.0版套裝統計軟體進行資料統計分析。研究結果發現：（1）護理人員對呼吸器相關肺炎照護知識平均得分7.87±1.36分（總分12分），答題正確率65.6%、照護態度平均分數34.2±3.0分（總分50分）、照護行為平均分數2.67±0.80分（總分5分）。在人口學屬性方面：年齡、服務科別、職稱及護理專業層級（P＜0.001）、ICU訓練證書（P＝0.003），與呼吸器相關肺炎照護行為達統計學顯著性差異。（2）照護行為與知識呈顯著正相關（r=0.38；P＜0.001），與照護態度呈顯著正相關（r=0.18；P＜0.05）。（3）預防呼吸器相關肺炎照護行為之重要預測因子為年齡、服務科別及預防呼吸器相關肺炎照護知識（F＝26.01），可解釋之總變異量達34.4%。本研究結果發現加護病房護理人員對預防呼吸器相關肺炎照護知識越高、態度越正向，其照護行為越正確，因此建議應加強護理教育訓練，提升知識及態度，進而改變臨床照護行為，以達預防呼吸器相關肺炎之目的。

關鍵字

呼吸器相關肺炎；組合式照護；知識；態度；行為

並列摘要

The aim of this study is to investigate the association among intensive care unit nurses’ knowledge, attitude, and practice for preventing ventilator-associated pneumonia (VAP). This cross-sectional study was conducted in a regional teaching hospital, and the nurses serving in the adult intensive care unit (ICU) and subacute respiratory care center (RCC) were recruited. Structured questionnaires were developed to collect demographic data, the score of knowledge, and attitude for preventing VAP. A total of 150 questionnaires were administered to ICU nurses. Among them, 142 participants responded, and only 133 questionnaires were classified as valid. From September 16, 2013 to September 30, 2013, observations of the clinical practices for preventing VAP, including hand hygiene, head-of-bed (HOB) elevation, and oral care were carried out by trained nurse practitioners. All statistical analyses were conducted by using the statistical package SPSS for Windows (Version 19.0, SPSS). The results of the study showed that the mean scores of VAP-associated knowledge, attitude, and practice for preventing VAP among intensive care unit nurses were 7.87 ± 1.36(full score, 12), 34.2 ± 3.0(full score, 50), and 2.67 ± 0.8(full score, 5), respectively. Age, department, title, ranking of nurse, and ICU-licensed qualification were found to be significantly associated with practice for preventing VAP (all P<0.05). In addition, practice was found to be positive correlated with knowledge (r=0.38, P<0.001) and attitude (r=0.18, P<0.05). Finally, we found that the most important predictors of practice for preventing VAP were age, department, and knowledge (F=26.01), which account for 34.4% of total variation. In conclusion, our findings confirm the positive correlation among ICU nurses’ knowledge, attitude and practice for preventing VAP. It suggests that we can improve the care practice for preventing VAP for ICU nurses by enhancing their VAP-associated knowledge and attitude.