探討護理人員對末期臨終照護之知識、態度及自我效能

An exploration of nurses’ knowledge, attitudes and self-efficacy toward end-of-life care

許向妤(Hsing -Yi Hsu)

指導教授 ： 陳幼梅

高雄醫學大學/護理學院/護理學系碩士班/碩士(2018年)

摘要

研究目的：探討護理人員個人屬性、專業屬性、末期臨終照護知識及態度對照護末期病人自我效能之相關性。
研究方法：採橫斷性研究設計，以立意取樣方式選取南部某醫學中心之護理人員504位為研究對象（有效回收率94.84%），利用結構性問卷進行資料收集。問卷內容包括：「個人基本資料表」、「末期臨終照護知識量表」、「末期臨終照護態度量表」、「末期臨終照護自我效能量表」，量表經信效度檢定，以SPSS for windows 20.0版中文套裝軟體進行描述性及推論性分析。
研究結果：(1)護理人員末期臨終照護知識平均得分13.46分(滿分20分)，答對率67.27％，呈現知識不足。教育程度越高、任職於安寧病房、工作職稱及進階層級越高、有參與院內外教育訓練、有照護末期病人經驗之護理人員，其臨終照護知識得分較高。(2)護理人員末期臨終照護態度平均得分3.88分(範圍1~5分)。教育程度較低、任職於急診，在臨終照護態度得分較低。(3)護理人員員末期臨終照護自我效能平均得分6.11分(範圍0~10分)。年齡40~49歲、已婚、教育程度較高、任職於安寧病房、工作職稱及進階層級越高、有參與院內外教育訓練、有照護末期病人經驗之護理人員，其臨終照護自我效能得分較高。(4)經皮爾森積差相關檢定，末期臨終照護知識、態度及自我效能皆為顯著正相關。(5) 複迴歸分析結果發現，護理人員年齡、臨床工作年資、工作單位、職務等級、有無照護末期病人經驗、末期臨終照護態度對臨終照護自我效能具預測力，共可解釋19.46％變異量，其預測力在個人屬性可解釋5.70％，專業屬性9.14％，末期臨終照護知識0.05%，末期臨終照護知識態度4.57%。
研究應用：臨床實務方面，醫院應讓第一線的醫護人員明瞭安寧緩和知識的重要性，爾後，在病人及家屬參與醫療決策過程中提供正確的知識，保障病人確實知情後做出選擇。在教育方面，建議往後在護理人員在職教育中，除了加強臨終症狀處理課程外，尚可安排提升靈性照護評估，才能落實緩和療護理念，讓病人達到善終目標。護理研究方面，未來可以質性研究方法，設計末期臨終照護態度、自我效能開放式題項，再進行後續歸類探討。研究亦可做為後續類實驗性研究參考，以不同教育方案進一步探討護理人員介入前、後末期臨終照護知識、態度及自我效能差異。

關鍵字

末期病人 ； 末期臨終照護 ； 自我效能

並列摘要

Purpose：A study to explore the correlation between personal character, professional specialty, knowledge and attitude in palliation and self-efficacy of palliative care.
Methods：The cross-sectional study was adopted with 504 nurses (response rate:94.84%) as purposive subjects selected from certain Medical Center in southern region. The data was collected via structured questionnaire. The content of questionnaire includes: “Basic personal information”, “Scale of Palliative Care Knowledge”, “Scale of Attitude toward Palliative Care”, “Scale of Self-efficacy for Palliative Care”. These scales have passed reliability and validity tests and the descriptive and inferential analysis were conducted based on Chinese version of SPSS for windows 20.0.
Results：(1) The average score of nurses in term of palliative care knowledge was 13.46 (full scores:20), the percentage of right answers was 67.27%, demonstrating knowledge deficiency. The ones with higher education would have higher position and advance level in palliative care. Those who had been participated in internal or external educational training and experiences of taking care end-of-life patients got higher score of palliative care knowledge. (2) The average score of nurses in term of attitude toward palliative care was 3.88 (range:1~5). Those who with lower education, serve at emergency room got lower score on attitude toward palliative care. (3) The average score of nurses in term of self-efficacy for palliative care was 6.11 (range:0~10). The nurses aged 40~49, married, with higher education, service at hospice wards, higher title and advance level, attending internal or external educational training, experiences on taking care of end-of-life patients got higher score of self-efficacy for palliative care. (4) According to Pearson product-moment correlation test, the palliative care knowledge, attitude and self-efficacy are all positively correlated. (5) It is found from the result of multiple regression analysis that the age of nurse, service seniority of clinical work, working unit, service level, experience on palliative care, attitude toward palliative care are available for the predictability of self-efficacy for palliative care. The predictability could explain 19.46% of variation, in which the personal character could explain 5.7%, professional property 9.14%, palliative care knowledge 0.05% and attitude toward palliative care 4.57%.
Application：In respect of clinical practices, the hospital shall have medical care personnel in the front line understand the importance of palliative care knowledge. Afterward, they may provide correct knowledge to patients and their family members during the medical decision making process, protect patients to make choice after they are actually informed. As to the education, in addition to the enhancement of palliative syndrome handling program, it is recommended to arrange the assessment for spirit care enhancement to carry out palliative care concept and achieve the goal of peaceful death. For nursing study, the qualitative approach could be used to design open questions for attitude toward palliative care, self-efficacy before subsequent categorized studies in the future. The study could also be the references for subsequent experimental studies to further discuss the difference of palliative care knowledge, attitude and self-efficacy before and after the intervention of nurses with different education projects.

並列關鍵字

end-of-life patients ； palliative care ； self-efficacy

參考文獻

朱育增、吳肖琪（2009）．國際安寧緩和療護發展及其對我國政策之啟示．長期護理雜誌，13(1)，95-107。

安寧照顧基金會（2017）．什麼是安寧療護．取自http://www. hospice.org.tw /2009/ chinese/about.php

安寧照顧基金會（2017）．現有合約醫院．取自http://www.hospice. org.tw/2009/chinese/hospital.php

全國法規資料庫（2017）．安寧緩和醫療條例．取自http://law.moj.gov.tw/Law/LawSearchResult.aspx?p=A&;t=A1A2E1F1&;k1=%E5%AE%89%E5%AF%A7%E7%B7%A9%E5%92%8C%E9%86%AB%E7%99%82%E6%A2%9D%E4%BE%8B

行政院衛生福利部醫事司（2013）．安寧緩和醫療條例．總統華總一義字第10200000811號。