加護病房護理人員護理決策、心肺復甦術技能與重症照護能力之相關性探討

本研究目的在探討加護病房護理人員在護理決策、心肺復甦術技能重症照護能力之現況，並探討重症照護能力之預測因子。研究方法採橫斷式的調查研究法，在台南地區一家醫學中心、一家區域教學醫院及兩家區域醫院，以立意取樣方式，選擇服務於加護病房且直接參與照護病患者（包含已完成職前訓練的新進人員）之護理人員為收案對象，共計發出274份問卷，回收263份問卷，回收率95.63％，扣除未填寫完整問卷5份，共計有效問卷共259份。採結構式量表，包括人口學及工作特性問卷、護理決策量表、心肺復甦術技能量表及重症照護能力量表等進行資料收集，並以SPSS14.0中文套裝軟體進行資料分析。研究結果發現：（1）所有受試者之重症照護能力總平均為71.96（±8.38）、護理決策之總平均值為58.78（±2.89）、心肺復甦術技能之總平均值為64.55（±9.01）；在人口學及工作特性部分：年齡（ｒ＝.34,p＜.01）、護理工作年資（ｒ＝.39,p＜.01）、ICU工作年資（ｒ＝.39,p＜.01）、2008年參與之重症教育時數（ｒ＝.26,p＜.01）與重症照護能力之間呈顯著正相關；擁有ICU證書（t＝4.97,p＜.05）、不同專業能力層級（F＝11.88,p＜.01）、不同職稱（F＝3.70,p＜.05）與重症照護能力之間呈顯著差異；（2）重症照護能力與護理決策（r＝-.25，p＜.01）、心肺復甦術技能（r＝.68，p＜.01）有顯著相關性，護理決策模式偏向使用分析決策模式、心肺復甦術技能越高者，其重症照護能力越好；（3）重症照護能力之預測因子為心肺復甦術技能、ICU工作年資和護理決策等三項（F＝76.80，p＜.01），可解釋重症照護能力的總變異量達47.5％。本研究結果建議在實務方面：可提供心肺復甦術技能的實務訓練，並將心電圖判讀列為實務訓練之一部份，及依據護理人員分級進行教育訓練規劃；在教育方面：強化學校教育納入ACLS及重症護理的課程；在研究方面：重視重症照護能力的測量及探討護理決策與護理情境之關係，以提升護理人員之重症照護能力，本研究結果可做為臨床實務訓練安排及護理行政政策擬訂之參考。

關鍵字

重症照護能力；護理決策；心肺復甦術技能；加護病房

並列摘要

The study aimed at not only exploring the status quo of nursing decision making, cardiopulmonary resuscitation (CPR) skills, and critical care competency of intensive care unit (ICU) nursing staff, but also examining the predictors of critical care competency. A cross-sectional study was conducted and a purposeful sampling was adopted to recruit ICU nurses, including the new ones that had finished pre-service training, who involved in direct patient care at a medical center, a regional teaching hospital, and two regional hospitals in Tainan. Total 274 questionnaires were sent out and 263 were returned, in which 259 were valid. The returned ratio was 95.63%. Structured questionnaires were utilized to collect demographic data, job characteristics, nursing decision making, CPR skills, and critical care competency. Data were analyzed by applying Chinese version of statistical analysis software SPSS14.0. Results indicated: (1) the mean(±SD)of critical care competency was 71.96(±8.38);mean for nursing decision making was 58.78 (±2.89);mean for CPR skills was 64.55 (±9.01). The demographic data and job characteristics were summarized as follows: age (r=.34, p<.01), years of work experience in nursing (r=.39, p<.01), years of work experience in ICU (r=.39, p=<.01), hours of critical care education in 2008, (r=.26, p<.01); holding ICU certificate (t=4.97, p<.05), different professional ladder levels (F=11.9, p<.01), and different titles (F=3.70, p<.05) were significantly correlated with critical care competency. (2) critical care competency was significantly correlated with nursing decision making (r=-.25, p<.01) and CPR skills (r=.68, p<.01); nurses who used analytical decision making model and those who had higher CPR skills had better critical care competency; (3) predictors of critical care competency were CPR skills, years of work experience in ICU, and nursing decision making (F=76.80, p<.01), which explained 47.5% of total variation. The results offer some suggestions on enhancing nursing staff’s critical care competency from three aspects: practice, both CPR skills and electrocardiogram (ECG) identification should be included in practical training, and in staffing education planning of clinical ladder system. For education: more emphasis should be placed on ACLS and critical care course at schools.For research, the measurement of critical care competency, and the relationships between nursing decision making and nursing situations should be explored. This research could be used for future reference in arranging nursing training courses in practice and making nursing administration policies.