醫院護理人員接受口腔衛生教育介入後對住院病人提供口腔照護知識、態度及行為之成效評估

研究背景口腔護理是全人照顧的一部分，其主要目的在幫助病人維持口腔清潔與舒適，有效的口腔護理能預防嚴重感染。而護理人員多因處理病人複雜的系統性疾病，而忽略病人口腔衛生，這與護理人員基礎訓練過程中，較少強調病人口腔護理重要性有關。目前國內的口腔保健推廣大多以幼稚園和小學的學童為主，但適用於護理人員提供住院病人口腔照護的教材不多，期望藉由口腔衛生教育課程的設計與介入，強調口腔照護的重要性，也有助於改變護理人員對口腔照護的態度及行為。研究目的本研究是藉由發展適用於護理人員口腔衛生教育的教學計畫活動，並進行口腔衛生教育課程介入，建立護理人員正確的知識、態度及行為。再探討口腔衛生教育介入後醫院護理人員對住院病人提供口腔照護知識、態度及行為之成效。研究方法本研究選取台南市兩家等級相同之區域教學醫院進行收案研究。研究對象為內科、外科、兒科、產科、成人加護病房、小兒加護病房、安寧病房之臨床護理人員，不包含護理長及專科護理師，實驗組146人、對照組104人。由牙科及口腔衛生專業人員擔任講師，對護理人員進行六小時的口腔衛生教育課程及一小時的臨床實際操作教學。研究工具為「護理人員對住院病人口腔保健相關知識、態度、行為調查」之問卷收集資料，研究時間長達近六個月。實驗及對照組護理人員問卷調查分別於教學前、教學後立即和三個月後施測。統計方法有描述性統計、雙樣本t檢定、卡方檢定、變異數分析。研究結果於介入後立即測試及三個月後的測試，護理人員的口腔衛生知識及態度分數都優於前測且高於對照組，皆達統計上的顯著差異（p＜0.05）；護理人員個人的口腔衛生行為在刷牙次數、方法、牙刷使用多久皆有明顯進步且高於對照組，而護理人員對住院病人口腔照護行為亦有明顯進步且高於對照組，皆達統計上的顯著差異（p＜0.05）。背景資料分析中，進階層級、工作單位、擔任職務、一年內有無接受口腔衛生教育課程和護理人員口腔衛生知識及態度的改變有相關。結論此次的口腔衛生教育介入是有成效的，課程設計可提供醫院推廣口腔衛生之參考。口腔清潔及口腔衛生，是有效避免住院病人口腔滋長細菌的一大關鍵，而護理人員在其中更是重要的推手，所以護理人員的口腔照護知識、態度及行為需不斷的維持及提升，而透過持續性的終身學習，來獲得口腔護理相關知識，是最具效果的。

關鍵字

醫院護理人員；教育介入；口腔衛生知識；口腔衛生態度；口腔衛生行為

並列摘要

Background Oral care is an important part of nursing. The main purpose is to help patients maintain their oral hygiene and comfort. Effective oral nursing care can prevent serious infection. The nursing personnel might ignore a patient’s oral hygiene because they deal with more complicated systemic diseases. This is attributed to their basic nursing training emphasizing less on a patient’s oral care. Presently, oral health care in Taiwan focuses mostly on pupils in nurseries and elementary schools. Otherwise, teaching material provided to in-patient oral care for nursing personnel is limited. Through a designed intervention oral hygiene teaching curriculum, we hope to emphasize not only the importance of oral nursing care, but also to alter the behavior and attitude of oral care in nursing personnel. Study Objectives The objective of this study is to develop a teaching program in oral hygiene education to establish proper knowledge, attitude, and behavior suitable for nursing personnel. This research also investigated the efficiency of nursing personnel providing in-patient oral care knowledge, attitude, and behavior after oral hygiene education. Methods The samples were selected from 2 district teaching hospitals in Tainan city.Samples included nursing personnel in the department of internal medicine, surgery, pediatrics,obstetric-gynecology, adult ICU, and pediatric ICU. Nursing heads and physician assistants were not included. A total of 250 nursing personnel were selected, 146 in the experimental group and 104 in the control group. A 6-hour oral hygiene lecture and 1-hour actual clinical training was conducted by dentists and oral hygiene professionals. The data was collected from a questionnaire titled “investigation of nursing personnel providing in-patient oral nursing care knowledge, attitude, and behavior”over a period of 6 months. The questionnaire was given in 3 time frames; before lecture, immediately after-lecture,and after 3 months, to the experimental and control groups. Descriptive analysis, match-paired t-test, and variable analysis were used for statistical analyses. Results The experimental group showed a higher score immediately after-lecture and after 3 months, as compared to the control group(P<0.05). Oral hygiene behavior of nursing personnel in frequency and method of tooth brushing, and duration of a toothbrush used scored higher than the control group(P<0.05).Background analysis found that oral hygiene knowledge and behavior in nursing personnel is related to status, working unit, assumed position, and weather they attended oral hygiene education within the previous year. Conclusion This study showed that oral hygiene education intervention is effective. The designed curriculum can be a reference for hospitals to promote oral hygiene. Oral cleaning and hygiene are a key to eradicate oral bacterial growth of in-patients, and nursing personnel should become a conduit. Therefore, consistent and up to date oral nursing care knowledge, behavior, and attitude to care is needed. The most effective way to learn oral nursing care related knowledge is through persistent life-time learning.