情境模擬敎育訓練介入對護理之家照顧服務員的失智症照護知識態度及行為之成效

Effectiveness of a Situational Simulation Education Training Intervention on Dementia Care Knowledge, Attitudes, and Behaviors among Nursing Care Attendants in Nursing Homes

郭怡利(Yi-Li KUO)

指導教授 ： 李淑杏

中山醫學大學/醫學院/護理系長期照護碩職專班/碩士(2022年)

https://doi.org/10.6834/csmu202200261

摘要

背景：台灣失智症人口增加且目前長期照顧機構照護需求率升高，照顧服務員是長期照顧機構中主要的照顧人力之一。在台灣照顧服務員課程多偏重基本照顧技巧訓練，因時數緊湊及多種課程及技術時間的擠壓下，失智症照顧課程僅有二小時，臨床實習也未要求失智症照護實作，照顧服務員需自行面對失智症患者多變化照顧問題，使照顧工作面臨許多挑戰，因此照顧服務員對失智症的照護技能急需提升。
目的：本研究的目的為探討失智症情境模擬敎育訓練介入對照顧服務員之失智症照顧知識、態度、行為改善之成效，期待照顧服務員能更有效地提供失智症所需的照顧。
設計：本研究採類實驗性研究設計(Quasi- experimental study design)。
方法：於2021年11月至2022年01月期間，以中部某四所護理之家的照顧服務員為收案對象，招募時用硬幣正反面分成實驗組與對照組兩組。本研究收案66位，實驗組36位、對照組30位，使用自擬「情境模擬敎育訓練介入對護理之家照顧服務員的失智症照護知識態度及行為之成效」問卷為測量工具。
實驗組與對照組完成前測後，實驗組給予情境模擬敎育訓練介入，實施課堂在職敎育及觀看教學影片15分鐘及隨機分2組情境演練共20分鐘，課後討論10分鐘。對照組則採常規無訓練課程。二組並於介入第2天及第4週進行後測。資料進行編碼，再以SPSS19.0版進行統計分析；敘述性與推論性分析含X2 test、T-Test、Mann-Whitney U test、repeated ANOVA與 GEE。
結果：本研究結果顯示實驗組及對照組在人口學、知識、態度及行為前測同質性高，但在年齡、有無失智症的親友、有無失智症者同住及照顧證照數有顯著差異。經由失智症情境模擬敎育訓練介入後，實驗組在介入第2天 (T1)及4週(T2)之知識、態度及行為後測皆有顯著提升(p<.01)。以GEE模式檢定發現組別、知識及照顧失智症患者(年數)，逹統計上顯著意義;顯示情境模擬教育訓練介入之實驗組、失智症照護知識、態度及照顧年數能提升及失智症照護行為。
結論：本研究藉由情境模擬敎育訓練介入提升照顧服務員對失智症照護知識、態度及行為，研究結果可提供後續照顧服務員職前訓練課程的培訓參考。

關鍵字

情境模擬敎育訓練 ； 照顧服務員 ； 失智症 ； 知識 ； 態度 ； 行為

並列摘要

Background: The number of people with dementia and the demand for care in long-term care institutions are increasing in Taiwan. Care attendants are one of the main care workers in long-term care institutions. Care attendant courses in Taiwan tend to focus on basic care skills training. Due to the long working hours and the time pressure of other various courses and techniques, the dementia care course is only two hours long. Moreover, clinical care attendants do not require dementia care practice. Thus, attendants must face the changing care problems of patients with dementia on their own, which brings many challenges. Therefore, the skills of dementia care attendants urgently need to be improved.
Objective: To investigate the effects of a dementia situational simulation education training intervention on care workers' knowledge, attitudes, behaviors, and ability to effectively provide the care needed by patients with dementia.
Methods: This quasi-experimental study design was conducted between November 2021 and January 2022 among care attendants at four nursing homes in central China. The 66 subjects were divided into the experimental group (n=36) and control group (n=30) by tossing a coin. The custom "Situational Simulation Educational Training Intervention on Dementia Care Knowledge, Attitudes, and Behaviors of Nursing Home Care Attendants" was used as a measurement tool. After both groups completed the pre-test, the experimental group received the situational simulation education training course, implemented classroom on-the-job education, watched teaching videos for 15 minutes, and were then randomly divided into two groups for situational exercises for a total of 20 minutes or after-class discussion for 10 minutes. The control group received the conventional no-training course. Post-tests were carried out two and four weeks after the intervention in the second group. Data were coded and statistically analyzed with SPSS version 19.0 using descriptive and inferential analyzes such as the X2 test, t-test, Mann-Whitney U-test, repeated ANOVA, and generalized estimating equations.
Results: The experimental and control groups had similar demographic features, knowledge, attitudes, and behaviors at pre-test, though there were significant differences in age, relatives and friends with or without dementia, living with or without dementia, and the number of care certificates between groups. After the intervention, the experimental group exhibited significant improvements in knowledge, attitudes, and behaviors in the post-tests two days (T1) and four weeks (T2) after the intervention (p<.01). GEE indicated the situational simulation education and training intervention, knowledge of dementia care, attitude, and number of years of caring were associated with improved care behaviors for dementia symptoms.
Conclusions: The situational simulation education training improved care attendants’ dementia care knowledge, attitudes, and behaviors. The results of this study provide a training reference for follow-up pre-job training courses for care attendants who work with patients with dementia.

並列關鍵字

situational simulated education training ； nursing assistant ； dementia ； knowledge ； attitude ； behavior

參考文獻

林麗味、蔣妃玫、陳見花、戴佑泫、蔡麗珍、葉淑惠（2016）．失智症照顧教育課程對日間照顧中心照顧服務員的照顧知識、態度及能力之成效．長庚護理，27（4），491-505。https://doi.org/10.3966/102673012016122704002

Humphreys, M. (2013). Developing an educational framework for the teaching of simulation within nurse education. Open Journal of Nursing, 3(4), 363–371. https://doi.org/10.4236/ojn.2013.34049

中文文獻：

衛福部長照專區(2021) ‧失智症防治照護政策綱領暨行動方案2.0(含工作項目)(2021年版。https://1966.gov/LTC/cp-4020-42469-201.html

衛福部統計處(2021) ‧醫療機構現況及醫院醫療服務量統計。https://dep.mohw.gov.tw/DOS/Ip-5099-113-xCat-y109.html