機構內失智症照護經驗照護者的口腔衛生知識、態度、行為與口腔照護經驗之關係：台灣中部地區之研究

近年來老人長期照護問題逐漸受到社會的重視，大約有75%的老年人有一種或是多種慢性病，其中老年失智症因疾病病程演變的特殊性，伴隨許多日常生活逐漸失能的狀況。而照護人員也欠缺正式且合乎機構需求的口腔保健訓練。國內對於針對機構的照護者之相關調查及文獻不多，希望能探討機構內失智症照護經驗者是否擁有正確的口腔衛生知識、態度、行為與了解口腔照護現況。本研究目的為瞭解台灣中部地區機構內失智症照護經驗者的口腔衛生知識、態度、行為與失智症照護經驗之關係。本研究採橫斷式研究設計，針對台中縣市、彰化縣內長期照護機構，以立意取樣方式選取11間長期照護機構，於2009年7月至9月間收集相關問卷，排除外國籍之照護者，有效樣本數為229，回收率85.77％，護理人員樣本數為88位，照顧服務員樣本數為141位，問卷資料收集完成後以Microsoft Access輸入存檔，Excel軟體作資料處理，再以JMP7.0與SPSS14.0套裝軟體做統計分析。以多變項對數迴歸分析，探討照護者之間高知識得分、高態度得分、口腔衛生保健行為、失智症住民口腔保健照護行為之影響因素。護理人員中口腔衛生知識平均分數為69.77 ± 13.48，影響因素為過去從事最久的職業；照顧服務員為58.63 ± 20.07，影響因素為態度分數。護理人員口腔衛生態度平均分數為69.42 ± 8.28 ，其影響因素為口腔衛生知識得分與過去從事最久的職業；照顧服務員為66.78 ± 8.06，其影響因素為口腔衛生知識得分。口腔衛生行為方面，55.68 ％護理人員一天刷牙少於三次；51.06％照顧服務員一天刷三次以上。有定期看牙醫之護理人員佔62.34％；照顧服務員佔59.65％。牙痛才去看牙醫之護理人員佔37.5％最多；照顧服務員佔57.47％。護理人員中有每天協助失智住民清潔口腔者佔50.00％；照顧服務員佔65.96％。影響照顧服務員是否每天清潔失智住民口腔的影響因素為婚姻狀況及服務的年資。護理人員口腔衛生知識高於照顧服務員，態度方面兩者均屬正向，然而失智症口腔照護行為方面兩者均需加強，失智症住民的口腔照護工作由照顧服務員提供為主，護理人員實際協助失智住民清潔口腔機會並不高，建議機構工作人員需接受口腔保健訓練課程、照護人員彼此分享口腔照護經驗及定期舉辦研討會。

關鍵字

失智症照護者；失智症照護經驗；口腔衛生知識；口腔衛生態度；口腔衛生行為

並列摘要

75% of the older adults had one or more chronic diseases. Among them, the elderly with senile dementia had some characteristics in the stages of the disease along with a functional disorder in daily life. Moreover, The caregivers in the institutions often lacked formal training in oral health care and lacked the curriculum which fitted in with the residents of the institution. The nurses and care aides in the institutions were highly responsible for the oral health care, but unfortunately there were limited research and documents for reference in Taiwan. The major purpose of this study was to investigate the relationship between social demography and oral health related knowledge, attitude and practice of the caregiver who had experience of care for the elderly with dementia. This research applied purposive sampling method through questionnaires sent to 11 long-term care institutions in the central Taiwan in 2009. There were 229 questionnaires collected(88 nurses and 141 care aides), with the 85.77% response rate, . The collected data were stored, processed and analyzed by Microsoft Access, Excel ,JMP7.0, SPSS14.0 respectively . The score of the nurses’ oral health knowledge was 69.77 ± 13.48; the influencing factor was the longest job engaged. And the score of the care aides’ oral health knowledge was 58.63 ± 20.07; the influencing factor was the oral health attitude score; The score of the nurses’ oral health attitude was 69.42 ± 8.28; the influencing factors were the oral health knowledge score and the longest job engaged. And the score of the care aides’ was 66.78 ± 8.06; The influencing factor was the oral health knowledge score. In the aspect of oral health practice, 55.68% nurses brushed their teeth less than three times a day and 51.06% care aides brushed their teeth three times more a day, but no nurse brushed their teeth once a day. 62.34% nurses and 59.65% care aides visited a dentist routinely. And 37.50% nurses and 54.47% care aides visited a dental clinic only when they had a toothache. 50.00% nurses and 65.96% care aides helped to clean the oral cavity of the elderly with senile dementia daily. The influencing factors that whether care aides help the residents with dementia to clean their oral cavity daily were the marital status and work period in the service. It’s a fact that the knowledge of oral health of the nurses in the institutions was better than that of the care aides there. At the same time, the attitude of them both was positive. And yet they both should have put more emphasis on their practice. The nurses did not often assist the elderly with dementia in cleaning their oral cavity daily.