加護病房護理人員對經口氣管內管留置病人口腔護理的知識、態度、執行方式及其相關因素探討

A Correlational Study among Critical Care Nurses Knowledge, Attitude, and Practice toward Oral Care in Patients with Oral Endotracheal Intubation

林盈秀(Ying-Siou Lin)

指導教授 ： 羅美芳

國立臺灣大學/醫學院/護理學研究所/碩士(2008年)

https://doi.org/10.6342/NTU.2008.10350

摘要

有效的口腔護理可增進病人舒適與預防口腔感染，雖然口腔護理是基礎的護理實務，但護理人員提供氣管內管留置病人口腔護理的確是一大挑戰。本研究目的為瞭解加護病房護理人員對氣管內管留置病人口腔護理的知識、態度與執行方式及其相關因素，以及預測經口氣管內管留置病人口腔護理執行方式之重要變項。
本研究以橫斷式調查法合併觀察法，採立意取樣，以自擬的結構性觀察表與結構性問卷，於2008年1月到4月於北部某醫學中心進行資料收集，共觀察六個成人加護病房，共31位護理人員執行經口氣管內管留置病人口腔護理的方式與步驟；並收集十二個成人加護病房，共205位護理人員之經口氣管內管留置病人口腔護理的知識、態度與執行方式等問卷資料。
研究結果發現，在實際觀察護理人員執行口腔護理和護理人員自我報告口腔護理使用的清潔工具與溶液，口腔棉棒與海綿潔牙棒是氣管內管留置病人口腔護理主要的清潔工具，清潔溶液主要選擇以自來水或開水稀釋的漱口水；口腔護理步驟平均得分百分比為74.2％；因護理人員所屬加護病房性質不同，護理人員選擇口腔護理之清潔工具、清潔溶液、清潔溶液使用方式及氣管內管固定方式有所不同；護理人員年齡越年長，其執行口腔護理步驟完整率越高；內科系加護病房護理人員執行口腔護理步驟的完整性顯著高於外科系加護病房護理人員。口腔護理知識平均得分百分比為51.8％，口腔護理態度平均得分百分比為67.5％，口腔護理理想的執行方式平均得分百分比為59.5％；護理人員的口腔護理知識得分越高，其口腔護理相關措施執行頻率越高。
加護病房資深護理人員的指導是護理人員學習氣管內管留置病人口腔護理之主要來源。護理人員學習氣管內管留置病人口腔護理的來源方式會影響護理人員對經口氣管內管留置病人口腔護理知識的瞭解程度、態度意向與口腔護理相關措施理想執行頻率；且護理人員學習氣管內管留置病人口腔護理來源數越多，其對經口氣管內管留置病人口腔護理的知識越瞭解、態度越正向。護理人員年齡越年長，其對氣管內管留置病人口腔護理相關措施理想執行頻率越高；腦中風加護病房護理人員比內科系加護病房護理人員，在氣管內管留置病人口腔護理相關措施執行上有較頻繁的理想執行頻率。由逐步迴歸分析，結果顯示腦中風加護病房（β = 0.23）、護理人員的年齡（β = 0.21）、急診加護病房（β = 0.16）與口腔護理知識（β = 0.14）四個變項可預測護理人員口腔護理執行方式，解釋量可達11.6％。
本研究建議護理人員藉由多元化的學習資源及持續性的終身學習來獲得口腔護理相關知識，以提昇護理人員對口腔護理的知識與態度；另外加護病房需依據單位病人性質建立氣管內管留置病人口腔護理規範、政策與流程，並以加護病房單位為中心進行相關在職教育訓練，期望提昇重症病人口腔護理的品質。

關鍵字

加護病房護理人員 ； 經口氣管內管留置病人 ； 口腔護理知識 ； 口腔護理態度 ； 口腔護理執行方式 ； 口腔護理步驟

並列摘要

Effective oral care improves patient comfort and prevents oral infection. Although oral care is a common nursing practice, providing intubated patients with oral care is a challenging task. This study investigated the knowledge, attitudes, practices and factors associated with oral care of intubated patients in intensive care units (ICU) and identified predictive factors for oral care of intubated patients by ICU nurses.
This study used a descriptive, cross-sectional design using purposive sampling to recruit nurses. Data were collected by structured questionnaires and observational checklist from January to April 2008 at a medical center in northern Taiwan. The observational data were the oral care procedures performed by thirty-one ICU nurses for intubated patients in six ICUs. The questionnaire examined 205 nurses' knowledge, attitudes and practices related to care for oral intubated patients in twelve ICUs.
The results showed that cotton swab and foam swab were the main oral care cleaning equipment used for oral intubated patients according to observations of ICU nurses performing oral care and self-reported questionnaires of ICU nurses. The cleaning solution was mainly dilute mouthwash. The mean correct rate was 72.4% in procedures of oral care. Due to the different characteristics of ICUs, the ICU nurses chose different cleaning equipment, cleaning solutions, methods of using cleaning solution, and oral endotracheal tube securement methods. Older age of the ICU nurses, was associated with more complete oral care. The completeness of performing oral care by the ICU nurses in medical ICU was significantly higher than that by nurses in surgical ICU. The mean correct rate about the ICU nurses’ knowledge of oral care was 51.8%. The mean rate about the ICU nurses’ attitude of oral care was 67.5%. The mean rate of ICU nurses ideally performed oral care procedure was 59.5%. Higher scores in oral care knowledge were associated with higher frequency of performing oral care.
Instructions from more experienced ICU nurses was the main source of learning oral care for intubated patients. The source of learning oral care for intubated patients affected the knowledge, attitude, and practice of oral care in ICU nurses. The more sources of learning oral care for intubated patients, the better the understanding and the more positive the attitude of the ICU nurses. Older age of ICU nurses was associated with higher frequency of performing oral care. The nurses in stroke ICU performed more frequently of oral care for intubated patients than the nurses in medical ICUs. The statistical results derived by stepwise regression analysis showed that four variables - stroke ICU (β = 0.23), age of ICU nurses (β = 0.21), emergency ICU (β = 0.16), and knowledge of oral care (β = 0.14) predicted oral care practice of ICU nurses. The four variables accounted for 11.6% of the total variance in ICU nurses’ oral care practice.
Based on the results of this study, we recommend that ICU nurses acquire knowledge related to oral care via various learning resources and continuous lifetime learning to advance their knowledge and attitudes regarding oral care. Additionally, ICUs must establish policies and procedures for oral care of intubated patients by characteristics of the patients. Further more, ICUs should provide on-the-job training and education of oral care in order to improve the quality of oral care in critical patients.

並列關鍵字

intensive care units (ICU) nurses ； intubated patient ； knowledge of oral care ； attitude of oral care ； oral care practice ； procedure of oral care

參考文獻

姚俐音（2007）。口腔護理對預防重症病患呼吸器相關肺炎發生之成效探討。未發表碩士論文。臺北：臺灣大學醫學院護理研究所。

范淑珍、黃月嬌、莊寶玉（2005）。置放口內氣管內管病患臉部皮膚暨口腔黏膜組織完整性缺損改善方案。護理雜誌，52（2），39-47。

陳瀅淳、邱艷芬、于博芮（2001）。壓瘡傷口照護的認知與行為。醫學教育，5（3），224-236。

簡淑玲、邱艷芬（2005）。加護護理人員對意識鎮靜之知識程度與所提供之護理活動相關因素之探討。醫護科技學刊，3（4），287-302。

蔡慧華（2005）。口腔分泌物抽吸在降低呼吸器相關肺炎之成效。未發表碩士論文。臺北：國立陽明大學臨床護理研究所。