台東某區域教學醫院失智症護理諮詢對於改善主要照顧者不確定感之成效

背景：罹患失智症之後的照護需求極高，照護的時間較長，照顧者承擔更高的生理與心理壓力，面對失智的確診，家屬會面臨極大的不確定感。目的：檢視護理諮詢照護提供家屬衛教與支持對於減輕照顧者不確定感的成效。方法：採類實驗性單組前後測設計，於東部某區域教學醫院神經內科門診由護理師進行第一次收案，提供衛教資料、資源整合網站、聯繫窗口，並於一個月後進行第二次收案，共34名失智症照顧者完成問卷填寫。量性資料採GEE分析，照顧者需求採質性內容分析。結果：失智症主要照顧者平均不確定感分數為86.4（SD=9.78），接受護理諮詢照護後，不確定感分數降為64.8（SD=7.58），但時間與宗教信仰呈現交互作用，具有宗教信仰的照顧者在接受護理諮詢照護後不確定感低於不具有宗教信仰的照顧者，故宗教對於不確定感有影響，因靈性慰藉而達到減輕不確定感之成效。在照顧者主要透過line行詢問，主要詢問的問題包括輔具資訊及照護技巧，資源提供次之如：居服資訊、失智症據點等相關資訊。結論：本研究結果可確認護理人員的諮詢照護可以有效降低失智症照顧者的不確定感及其需求；並了解宗教信仰對於不確定感有影響，此研究結果有助於發展失智症護理專家角色，提供個別性的照護以協助照顧者面對失智症照護所造成的不確定感。

關鍵字

失智症；家屬不確定感；護理諮詢

並列摘要

Background: Patients with dementia have a markedly high demand for care. The duration of care for patients as well as the physical and psychological stress on the patients’ caregivers increase if the patients are confirmed to have dementia, in turn resulting in a great sense of uncertainty in their family members. Objective: To investigate the effectiveness of providing health education, and support through nursing consultation to the family members (and caregivers) of patients with dementia on reducing the caregivers’ sense of uncertainty. Methods: This study adopted a quasi-experimental one-group, pretest–posttest design to recruit caregivers of patients treated by the department of neurology of a teaching hospital in eastern Taiwan. The caregivers were recruited by the department nurses. The nurses provided health education information, a website with integrated resources, and a contact window to the caregivers. The posttest was conducted a month later. A total of 34 caregivers completed the questionnaires, in which quantitative data were analyzed using generalized estimating equations and qualitative data (i.e., caregiver needs) were analyzed using content analysis. Results: The patients with dementia’s primary caregivers had an average uncertainty score of 86.4 (SD = 9.78), which decreased to 64.8 (SD = 7.58) after receiving nursing consultation and care. However, time and religious beliefs had an interaction effect on the caregivers’ uncertainty scores, that is, despite the decline in caregivers’ sense of uncertainty over time after receiving nursing consultation and care, the decrease was less significant among those who were religious. In general, all the caregivers asked questions via Line, with their enquiries mostly revolving around assistive device information and care techniques, followed by resource provision (e.g., home care information and dementia service locations). Conclusion: The results of this study verified that nursing consultation, support, and care provided by nurses can effectively reduce the sense of certainty among caregivers of patients with dementia, and help nurses understand the caregivers’needs. Additionally, the results can help improve the roles of dementia care experts, enabling them to provide customized care and help caregivers face the sense of uncertainty when caring for patients with dementia.