- 學位論文
口腔照護執行者的口腔衛生知識、態度、執行狀況與中風病人口腔衛生之相關性探討
The Association between the Oral Hygiene Condition of Stroke Patients and Knowledge, Attitude, and Behavior of Primary Caregivers on Oral Hygiene
摘要
對中風後發生認知或身體功能損傷的病人來說，口腔護理是一項具有挑戰性的任務，但口腔護理卻不被視為臨床上的照護重點，使得中風病人的口腔衛生與安全暴露在高度危險之中；由於台灣急性中風病人的口腔護理多由家屬或看護協助完成，因此，本研究的目的旨在了解急性中風病人口腔照護執行者(病人本人、家屬或看護)的口腔衛生知識及態度、口腔護理執行狀況及其預測因子，了解病人的口腔衛生狀態，並探討急性中風住院病人之口腔照護執行者知識、態度、執行狀況與病人口腔衛生狀態的關係，以做為臨床護理之參考，期能協助病人或照護者執行良好的口腔護理，共同維持病人的口腔健康，減少相關合併症的產生。 本研究為描述性相關性研究，採橫斷式調查法，以結構式問卷及口腔檢查評分表進行調查，於台北市某醫學中心神經內科、神經外科、家醫科、整合醫療、及老人醫學病房進行收案，共收集有效問卷81份。所得資料以SPSS 18.0軟體建檔，並以描述性統計(平均值、標準差、次數分配、百分比)及推論性統計(獨立樣本T檢定、變異數分析及逐步迴歸分析)等方式，分析病人的人口學、臨床特性、口腔照護執行者的人口學特性、口腔衛生知識、態度及口腔護理執行狀況與病人口腔衛生狀態間的關係。 研究結果發現：(一)口腔照護執行者與病人的關係為口腔衛生知識的主要預測因子：與外籍看護相較之下，病患服務員的口腔衛生照護知識較佳；(二)口腔照護執行者與病人的關係及年齡為口腔衛生態度的主要預測因子：病患服務員的口腔衛生態度優於外籍看護，外籍看護的口腔衛生態度優於病人本身，而年齡大於等於65歲的老年口腔照護執行者的口腔衛生態度優於年齡小於45歲的青壯年照護執行者；(三)口腔照護執行者的口腔照護資歷及年齡為口腔護理執行狀況的主要預測因子：口腔照護資歷愈久，口腔照護執行者的口腔護理執行狀況愈好，而年齡大於等於65歲的老年口腔照護執行者的執行狀況優於年齡小於45歲的青壯年口腔照護執行者；(四)多變項迴歸分析結果顯示，預測個案口腔衛生狀態的三類變項因素包括：(1)口腔照護執行者方面：與病人的關係、性別、最近一年口腔衛生相關課程上課主題是病人口腔衛生狀態的預測因子，即外籍看護優於病患服務員、男性照護執行者優於女性照護執行者、最近一年曾上潔牙課程的照護執行者優於不曾上過潔牙課程者，(2)病人特性方面：沒有加重口腔衛生照護需求因子的個案，其口腔衛生狀態越好；即沒有加重口腔衛生照護需求因子的個案，其口腔衛生狀態最佳，及(3)口腔護理執行狀況，即口腔照護執行者的口腔護理執行狀況愈好，其所照顧個案的口腔衛生狀態愈好。
並列摘要
Oral care poses a challenge in the clinical care of stroke patients with cognitive or physical functional impairments. Oral care is usually ignored in clinical settings and patients are often at high risk of oral disease. In Taiwan, the oral care of acute stroke patients is mostly carried out by family members or private caregivers (including local and foreign caregivers). This study examines the correlation among oral health knowledge, attitudes, and care behavior of oral care executors (patients themselves, family members, or private caregivers) and the oral hygiene of stroke patients. The results of this study offer the new knowledge on variables that influence patients’ oral hygiene and provide reference to improve clinical care and oral health practices to maintain patient oral health and avoid stroke-related complications. A descriptive correlation and cross-sectional study was designed through the use of a structured questionnaire and a scale of bedside oral examination. Eighty-one subjects were recruited among stroke patients from neurological, neurosurgery, family medicine, multidisciplinary combined care, and geriatric wards from one medical center in northern Taiwan. SPSS (ver 18.0) was used for data analysis. Descriptive statistics (mean, standard deviation, frequency, and percent) and inferential statistics (independent sample t-test, analysis of variance, and stepwise regression) were calculated to reveal the correlations among the demographics, clinical characteristics, and the oral hygiene condition of subjects and their demographics, oral health knowledge, attitudes, and care behavior of oral care executors. The results showed that: (1) the relationship of the oral care executors and patients was the main predictor of oral health knowledge. For example, local caregivers had better oral health knowledge when compared to foreign caregivers. (2) The age of oral care executors and their relationship to the patient were the main predictors of oral health attitudes as follows: the group over 65 years of age had better attitude score than the group under 45 years of age; and local caregivers were better than foreign caregivers, and both groups were better than patients. (3) The age and clinical experience of the oral care executor were the main predictors of oral care behavior: the group over 65 years of age was better than the group less than 45 years of age; the more experienced the oral care executor, the better the grade in oral care behavior. (4) Multivariate hierarchical multiple regression analysis indicated that there were three variables that influenced patient oral hygiene: (a) Oral care executors: The relation to the patient, gender, and attendance in an oral health course during the past year were the main predictors of patient oral hygiene. Foreign caregivers were better than local caregivers; males were better than females; and individuals who received training courses on oral hygiene were better than those who did not. (b) Subjects: The less the patient had oral health impairing factors, the better the oral hygiene condition of the patient; patients who did not have factors that may impair oral health had better oral hygiene conditions than those who did. (c) Oral care behavior: the better the oral care behavior of the oral care executor, the better the oral hygiene condition of the patient.