護理師之憂鬱相關精神健康識能調查研究

研究背景　　憂鬱症是常見且導致高疾病負擔的常見精神疾患，全球失能人年疾病導因之第二位即為重鬱症，而憂鬱症也是造成自殺的精神疾患第一位，但自殺死亡個案於生前一個月內僅19.7%經非精神科醫師發現為精神疾病，辨識率並不高。然而基層醫療場域中，經常會有慢性身體疾患且與精神疾患共病的病人，非精神科護理師面對此類疾病往往缺乏照護介入技能，甚至有負向態度或汙名，顯示出護理師有提升憂鬱相關精神健康識能之需求。精神健康識能被定義為「一般人對精神疾患的知識與信念」，醫護人員精神健康識能的提升不僅影響自身的精神健康，也會影響所接觸的人。目前護理領域的憂鬱相關精神健康識能研究不多，值得進一步探索，作為後續提升護理照護品質及精神健康識能教育訓練的實證基礎。研究目的　　本研究主要目的如下：（1）瞭解護理師之憂鬱相關精神健康識能現況。（2）探討憂鬱症態度問卷用於護理師族群的適用狀況。（3）探討護理師不同的前置因子（含基本人口學背景、憂鬱相關教育訓練經驗、及憂鬱症狀接觸經驗）與憂鬱相關精神健康識能的關係。（4）瞭解護理師照護具憂鬱傾向病患之需求與困難。研究方法　　本研究採橫斷式調查方法，以Google表單建立網路問卷，內容包含：個人基本屬性表、憂鬱症狀之接觸經驗、精神健康認知、憂鬱症態度問卷、自殺認知量表，其中精神健康認知其中一題半結構式問句用於了解護理師對憂鬱患者之照護需求。研究者以立意取樣收取北部某大型教學醫院病房護理師為對象，經單位護理長同意後，至各受試單位逐一說明研究、徵得護理師同意、並發放研究參與邀請函。研究結果共245位護理師參與本研究，研究發現，約半數的護理師能夠準確辨識出憂鬱症狀、但自殺風險程度的正確辨識僅有16.7%；而憂鬱症狀歸類的部分，約三分之二的護理師可以正確歸類為憂鬱症。量表信效度分析方面，憂鬱症態度問卷具有一定的內在一致性及因素結構，依量表的四個因素(即憂鬱症治療看法、憂鬱症照護能力、憂鬱症治療信心、憂鬱症原因解讀)分析後，發現護理師在「憂鬱症治療看法」與「憂鬱症原因解讀」兩者得分較高（偏向同意）、「憂鬱症照護能」偏向中立、「憂鬱症治療信心」則偏低分（不同意）。此外，自殺認知量表的調查發現約一半的護理師對自殺意念與自殺危險因子較具迷思態度，約六成的人在自殺求助與自殺處遇有較正確的想法。工作單位屬性為精神科或曾在精神科工作一年以上者，與過去或一年內曾接受憂鬱識能訓練者，其憂鬱相關精神健康識能較佳。護理師認為臨床工作忙碌與缺乏專業知識是他們照護病人時面臨的困難，照護有憂鬱症狀的病患時，有多項教育訓練之需求。研究結論本研究發現半數左右的護理師可辨識出個案情境中的憂鬱症狀並予歸類為憂鬱症，然而自殺風險的辨識能力及迷思態度較需加強。針對臨床工作忙碌、自覺憂鬱症狀專業知識不足、以身體症狀為評估主軸而未關注心理症狀、或認為缺乏一致性的評估標準等原因，都導致護理師處遇憂鬱個案上的困難，此結果反映出護理師有憂鬱相關精神健康識能之教育訓練需求。此外，除了增加護理師自身的憂鬱相關精神健康識能外，加強醫療環境中的行政支援如非精神科單位與精神科的照會連結及團隊合作，都是提升臨床憂鬱個案照護的重要因素。

關鍵字

精神健康識能；護理師；憂鬱；自殺

並列摘要

Background Depression is a common mental disorder that impact people greatly and cause high Global Burden of Disease. The burden of disease is illustrated in major depression, which is the second causation of Years Lived with Disability. Furthermore, although depression is the most frequent mental illness lead to suicide, only 19.7% of suicide deaths were diagnosed as mental illness by non-psychiatric physicians within one month before death which means recognition rate are so low. However, in practical hospital settings, patients often have comorbidity with chronic physical illnesses and mental illnesses. Non-psychiatric nurses lack the intervention skills, and even have negative attitudes or stigma toward these types of patients. This indicates a strong educational need for depression-related mental health literacy. Mental health literacy has been defined as“the knowledge and beliefs of the general population toward mental disorders.” Not only affects individuals themselves, but affects the people they are in contact with, as well. Research in depression related mental health literacy among nurses does not receive as much attention as it should. This issue needs further exploration to improve the effectiveness of depression related mental health education. Aim The main purpose of this study is: (1) To know the current status of depression -related mental health literacy in nurses. (2) To explore the applicability of the Depression Attitude Questionnaire to the nurse. (3) To explore the relationship between different predisposing factor of nurses and depression-related mental health literacy. (4) To understand the needs and difficulties of nurses taking care of patients with depressive symptoms. Method This cross-sectional study used online questionnaire to collect data from clinical nurses. The contents of the questionnaire included demographic and nursing background, and mental health literacy related variables: recognition, attribution, and attitude of depressive symptoms. Three case vignettes and two main scales were adopted to measure depression related mental health literacy. Scales named Depression Attitude Questionnaire, and Suicide Myth Questionnaire. This study were conducted in a university-affiliated hospital. After the consent of the head nurse, researcher visited each ward to explain the study one by one, obtained the consent of the nurse, and issued the research invitation letter. The participants took part in the study voluntarily by ticking the consent form online. Results In study period, 245 nurses participated in the study. The result showed that almost half of the nurses were able to accurately identify the depressive symptoms in case vignettes, but the correct identification of the level of suicide risk was only 16.7%. When participants were asked to present with depressive symptoms, two-thirds of the nurses can correctly attribute to depression. After factor analysis, we found that our major measurement, the Depression Attitude Questionnaire, had equivalent internal consistency and factor structures. According to the results of the exploration factor analysis, we analyzed the level of consent among nurses on the following four aspects: “Perspective of depression treatment”, “Depression care ability”, “Negative attitude of depression treatment”, and “Interpretation of depression”. Results showed that nurses tended to agree in both “Perspective of depression treatment” and “Interpretation of depression”, were neutral in “Depression care ability”, and disagreed in “Negative attitude of depression treatment.” In addition, the results of the Suicide Myth Questionnaire showed that almost half of the nurses had misconceptions on “suicide attempts” and “suicide risk factors”. Around 60% of participants had more correct ideas about “help-seeking” and “suicide management”. Nurses who worked at psychiatric wards or had more than one year of psychiatric experience, and those who had received depression-related mental health training in the past or within one year, the results showed that their level of depression-related mental health literacy were significantly higher. In addition, nurses believe that busy clinical work and lack of professional knowledge are the difficulties they face when caring for patients with depressive symptoms. When caring for patients with symptoms of depression, there are many needs for education and training. Conclusion This study found that half of the nurses were able to accurately identify depressive symptoms in case vignettes and attributed to depression. However, the recognition level of suicide myths and risk identification abilities of the nurses need to be improved. The results revealed that certain obstacles interfered with the management of depressive patients, such as lacking of time, lacking of adequate knowledge of depression, focusing mainly on physical symptoms rather than both psychological and physical symptoms, and lacking of consistent assessment standard of depression. These results indicated the educational and training needs of depression related mental health literacy for the nurses. Except for enhancing the level of mental health literacy, it is also important to strengthen the nurses’ administrative support in the hospital, including consultation-liaison and cooperation between non-psychiatric units and the psychiatric team.

並列關鍵字

Mental Health Literacy ； Nurses ； Depression ； Suicide

參考文獻

Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. (1999). Health literacy: Report of the council on scientific affairs. JAMA, 281(6), 552-557. doi:10.1001/jama.281.6.552

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