建構護理學生對性健康照護之態度與護理處置行為意向的整體模式

Constructing a Model on Attitudes and Intensions of Nursing Intervention on Sexual Health Care among Nursing Students

黃正宜(Cheng-Yi, Huang)

指導教授 ： 李選

中山醫學大學/醫學院/醫學研究所/博士(2013年)

https://doi.org/10.6834/CSMU.2013.00205

摘要

性是健康概念中的核心項目，與生活品質關係密切，性健康涵蓋身體、心理與社會三大層面，老化、生活意外、疾病過程與治療都可能影響以上層面的健康，直接或間接的傷害性健康。許多護理人員雖了解疾病與治療對病人的性健康影響深遠，但臨床發現，其對病人性健康議題的討論仍顯不足。護理教育中的實習經驗，影響護生畢業後的職能。若能透過探討護生實習歷程中對性健康照護的態度與行為意向，將有助於了解臨床性健康照護的現況。
本研究目的在建構以PLISSIT(permission, Limited Information, Specific Suggestion, Intensive Therapy)模式為內涵之護理處置模式，且驗證護理學生以此模式提供性健康照護態度與處置行為之意向。本研究採橫斷式研究(Cross-sectional research)設計，以中台灣兩所護理學校之學生為樣本，樣本數160人，以團體施測方式完成結構化自填式問卷。研究工具包含：「性健康照護態度量表」、「性健康護理處置行為意向量表」與人口學基本資料。研究工具之效度經內容與建構效度檢測，量表的信度則經再測信度、內在一致性考驗。最後以SPSS18.0統計軟體進行相關檢定，以了解「護理系學生對性健康護理處置之態度及行為意向」。
研究結果發現，性健康護理處置行為意向，經因素分析萃取三個因素為: 「允許」、「限制性資訊」及「特定性建議」因素，其Cronbach’s α分別為.83, .89, .90；性健康照護態度萃取四個因素為: 「允許」、「限制性資訊」、「特定性建議」及「深入治療」四個因素，其Cronbach’s α分別為.70, .80, .71, .70。護生對性健康照護之態度與行為意向模式適配度指標(X2/df = 1.509; RMSEA = 0.057)顯示理論模式與資料的適配度獲得支持。性健康護理處置行為意向模式中，「性健康照護之態度」及「性活動程度」會直接影響護生的「性健康護理處置行為意向」(β = .34, p<.05; β= .27, p<.05)。整體而言，本研究建立了具良好信度與效度的本土化「性健康照護態度量表」與「性健康照護護理處置行為意向量表」。性健康照護的態度與性活動程度對於性健康護理處置行為意向有直接影響成效。
建議未來研究可針對醫護人員進行縱貫性研究，依據實際之性健康照護行為進行模式建構，進行性健康護理教育的成效評估，或將行為意向與真實行為追蹤比較。變項之分析建議增加臨床工作單位屬性、年資等變項分析，可強化因果的推論效果，作為促進性健康照護之參考。

關鍵字

性健康照護 ； 行為意向 ； 態度 ； 護理系學生

並列摘要

Sexuality is an essential component of health, which is a significant determinant of quality of life. Sexual health was defined as the integration of somatic, emotional and social aspects, which can be hampered by aging, accidents and disease processes. Most of nurses have recognized that sexual dysfunction is highly comorbid with many diseases and treatment, but they reluctance to address sexual health issues in clinical. Nursing practice course is the stone of nursing education, has profound effect on future. Exploring nursing students’ attitude and behavior intension on sexual health is helpful to understand the reality of sexual health care in clinical.
The aim of this study was to construct the nursing intervention based on the Permission, Limited Information, Specific Suggestion, and Intensive Therapy (PLISSIT) model, and validation the model on attitudes and intension of nursing intervention among students on sexual health care. This is a cross-sectional study, a purposeful convenience sample of 160 senior nursing students from two central Taiwan medical universities was enrolled in the study. The instruments used in this study included the 「Nursing Attitudes in Sexual Health Care」(NASHC)、「Nursing Interventions on Sexual Health」(NISH). All scales were examined for content and construct validity as well as for reliability, including test-retest reliability, internal consistency, and construct validity. We conducted structural equation modeling to examine the proposed conceptual model, using SPSS 18.0 statistical software.
The results indicated three factors (permission, limited information, and specific suggestion) were retained after exploratory factor analysis of NISH, and Cronbach’s alpha for the subscales were .83, .89, .90. There were four factors (permission, limited information, and specific suggestion, intensive therapy) were extracted after exploratory factor analysis of NASH, the Cronbach’s alpha for the subscales were .70, .80, .71, .70. The hypothesized model provided a good fit with the data (X2/df = 1.509; RMSEA = 0.057). Within the behavioral intentions of sexual health care model, attitude of sexual health care and sexual activity level had a significant direct effect on intention of nursing intervention on sexual health (β = .34, p<.05; β= .27, p<.05). Overall, the study developed NISH and NASHC scales, which were useful and reliable scales for assessing the intention and attitude on sexual health care. The attitude of sexual health care and sexual activity level had a significant direct effect on intension on sexual health.
Further research should develop the longitudinal study, collecting the actual performance on sexual health care to construct model, evaluating the effectiveness of sexual health education and treatment-related intervention, or comparing the intention and actual performance. Analyzing variable should include clinical setting, years in nursing to strength the representativeness of finding.

並列關鍵字

sexual health care ； intension ； attitude ； nursing students

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