探討居家照服員的口腔照護認知、技能、自我效能與行為之相關性

Oral care related knowledge, skills, self-efficacy, and behavior among homecare workers

朱雯蘭(Wen-Lan Chu)

指導教授 ： 黃曉靈

共同指導教授 ： 黃純德(Shun-Te Huang)

高雄醫學大學/口腔醫學院/口腔衛生學系碩士在職專班/碩士(2018年)

摘要

研究背景：
口腔衛生是極為重要的，因為口腔衛生與身體其他疾病息息相關；口腔衛生不良導致口腔疾病如:齲齒、口臭、牙周病、口腔黏膜疾病等；口腔衛生不良導致牙齦疾病使糖尿病患者的血糖值難以控制或者血糖值不穩提高罹患牙齦疾病的風險；口腔細菌容易引起身體慢性發炎症與心臟病、中風等心血管疾病相關；研究顯示口腔衛生不良致使口腔細菌進入肺部引發肺炎，而肺炎是高齡者致死的重要原因。衛福部公布2016年十大死因，肺炎已由第四位升至第三位，且肺炎死亡人數中有九成是高齡者。對有長期照護需求的人來說，口腔衛生特別重要，長期照護需求者因身體機能衰弱造成功能不佳，口腔肌肉萎縮影響咀嚼吞嚥功能、口水分泌少降低自體清潔口腔能力，若照顧者沒有協助清潔容易造成齒頸部齲齒、殘根增加、口臭等影響甚大。
研究目的：
本研究目的為了解居家照顧服務員的居家個案口腔照護現況外還期望未來可提升居家照顧服務員口腔照護的技巧及行為，增強居服員專業服務的表現，強化家屬認同居服員是專業服務人員的觀念。
研究方法：
本研究設計為橫斷性調查，抽樣方法為立意取樣，研究工具為使用自填式問卷收集知識、自我效能、技能、行為的資料，統計法以次數分佈、百分比分析研究對象的基本資料；以邏輯斯迴歸比較研究對象之口腔認知、自我效能、技能及行為相關變項。
研究結果：
研究結果顯示過去口腔照護行為中沒有執行照護行為者分別為：站在可坐立個案後方來協助刷牙 (67.1%)、協助個案清潔口腔頰側的黏膜(71.1%)、協助個案清潔舌背(75.7%)、協助個案清潔口蓋上部位(76.3%)、協助口乾症個案在清潔口腔前先濕潤口腔(82.1%)、協助牙關緊閉個案在清潔口腔前作去敏感按摩(91.3%)、協助有鼻胃管的個案清潔口腔(83.1%)；過去1年內接受口腔衛生教育的次數1次(43.9%)、<1小時(50.9%)來源為在職教育課程；「有牙齒者刷牙不一定要用牙刷，可使用海綿棒替代」是知識題中答對率最低(30.6%) ； 「協助臥床張口呼吸個案清潔口腔順序」是技能題答對率最低(9.2%)。在多變項邏輯斯迴歸分析中發現：站在個案後方協助刷牙與年齡(20~50歲、50~70歲)(OR=2.802,95%CI=1.171,1.702)及平均花費時間(沒有照護、1~5分、>6分) (OR=6.603,95%CI=2.865,15.221)、清潔口腔頰側的黏膜與平均花費時間(沒有照護、1~5分、>6分) (OR=6.375,95%CI=2.599,15.637)及困難度(沒有，困難，容易) (OR=3.027,95%CI=10419,6.458)、清潔舌背與困難度(沒有，困難，容易) (OR=5.441,95%CI= 2.117,13.983)、清潔口蓋上部位與平均花費時間(沒有照護、1~5分、>6分) (OR=4.106,95%CI=1.694,9.953)及困難度(沒有，困難，容易) (OR=3.964,95%CI=1.657,9.480)、協助口乾症個案在清潔口腔前先濕潤口腔與平均花費時間(沒有照護、1~5分、>6分) (OR=4.803,95%CI= 1.846,12.495)及自我效能總分(OR=1.077,95%CI= 1.003,1.156)、協助牙關緊閉個案在清潔口腔前作去敏感按摩與困難度(沒有，困難，容易) (OR=5.751,95%CI=1.104,29.964) 及自我效能總分(OR=1.098,95%CI= 1.014,1.188)、協助有鼻胃管的個案清潔口腔與平均花費時間(沒有照護、1~5分、>6分) (OR=3.623,95%CI=1.397,9.395)及困難度(沒有，困難，容易) (OR=3.471,95%CI=1.277,9.434)，在統計分析上都有達顯著相關，p值<0.05。
結論：
居服員平時工作內容約70%以上皆無執行口腔照護，顯示照護行為比例低而影響行為因素是自我效能。建議照顧服務員培訓課程應納入技能強化訓練。

關鍵字

居服員 ； 口腔衛生

並列摘要

Background: Oral hygiene is very important especially for those people who are disability and ageing. It can reduce long-term cases suffering from infection. The objective of this study is to evaluate oral care related knowledge, skill, self-efficacy, behavior among homecare workers.
Objective: The purpose of this study was to evaluation oral care related knowledge, skills, self-efficacy and behavior among homecare workers.
Material and methods: The study designed cross-section study. Three groups of homecare worker centers were selected in Kaohsiung city of Taiwan. There were 173 participants completed questionnaire survey. A self-administered questionnaire was used to collect data about oral hygiene knowledge, skills, self-efficacy and behavior. Logistic regression was used to examine the related of knowledge, skills, self-efficacy and behavior in participants.
Results: Most of theses homecare works are female in age group 50~60.They had oral hygiene education for one time in the past year (43.9%). They had oral hygiene education less than one hour in the past year (50.9%). 「Toothbrushing does not necessarily use a toothbrush, but can be replaced with a sponge stick」got the lowest point in knowledge(30.6%). 「The sequence of assisting case in bed with opening mouth breathing to clean their oral」got the lowest point in skills(9.2%). Toothbrushing is one project in body cleaning, but more than 70% homecare workers do not to do that indeed.
Conclusion: The reason that over 70% homecare workers do not to assisting case brush their teeth are they do by their leaders’ orders or home caregivers’ orders, so even body cleaning contain toothbrushing but it is not necessary to do that.So, it is very important that not only to improve homecare worker’s leaders and home caregivers’ knowledge but homecare workers oral hygiene skills.

並列關鍵字

homecare workers ； oral hygiene

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