居家護理師對口腔照護相關知識、態度、自我效能及照顧行為之探討

Oral care related knowledge, attitude, self-efficacy and behavior of home care nurses

楊淑娟(Shu-Chuan Yang)

指導教授 ： 黃純德

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(2017年)

摘要

研究背景：接受居家護理服務個案常因長期的系統性慢性疾病，導致生理功能多種障礙，導致自我照顧能力缺陷。口腔衛生照顧能力缺失導致吸入性肺炎等嚴重合併症。居家護理師是提供到宅指導中要專業人員居家護理師對口腔照護之指導能力影響個案之照顧品質。但是文獻上對於居家護理師的口腔照護指導能力及照護自信度仍缺乏實證探討。
研究目的：探討居家護理師對口腔保健相關知識、態度、自我效能及照護行為間之相關係。
研究方法：本研究為橫斷性調查研究，研究對象為高雄市與屏東縣有 91 間居家護理所知居家護理師。於 106 年 2 月 23 日-3 月 24 日以郵寄方式寄出 225 份問卷。共回收有效問卷 167 份，回收率為74.22%。
研究結果：居家護理師在知識方面對牙齒結構上知識是足夠的，但對疾病（47.90％）與藥物（8.38％）等所造成口腔知識認知是極為不足。
對口腔保健照護「口腔護理相關知識」、「口腔護理技巧」、「口腔照護技巧」、「潔牙工具選擇」、「提供口腔照護設備」、「口腔護理的時間」等態度呈現分數偏低。自我效能方面，對口腔保健照護能力只有五成把握認為可以完成。照護行為方面，對於缺牙的潔牙工具選擇47.90％仍以海綿、棉棒等不符合口腔照護工具者居多，表示居家護理師對口腔照護工具選擇執行能力不足。只有 30.54%參與口腔教育訓練課程。
結論：本研究發現不同年代對於基本口腔照護教育內容差異性很大建議護理人員在口腔照護教育需要從學校養成基礎教育提升做，且教育內容需要更新符合實際照護狀況；另外，也需要規劃更多在職或進階教育，以提升居家護理師對居家個案及家屬提供正確口腔照護知識及技巧。進而降低居家個案吸入性肺炎而入院或死亡機率。如此才有正確性的口腔照護和良好的口腔照護品質。

關鍵字

居家護理師 ； 口腔 ； 知識 ； 態度 ； 自我效能 ； 照護

並列摘要

Background: Because of long-term systemic chronic diseases, home care cases often experience multiple physical disabilities and become self-care deficiencies. Being unable to perform appropriate oral hygiene care often
causes a person suffering severe complications, such as pneumonia. Home care nurses are the only medical staff of providing in-home education and services. Home care nurses’ knowledge, attitude, skills, and teaching ability of oral hygiene care is the key factor for the care quality of home care cases. However, home care nurses’ teaching ability and self-efficacy of performing oral hygiene care is still under reported.
Objective: The purpose of the current study is to explore home care nurses’ knowledge, attitude, skills, and self-efficacy of performing oral hygiene care.
Material and methods: This study was a cross-sectional design. Subjects were home care nurses of 91 home care centers, registered in Kaohsiung city and Ping-tung County. During 2017/2/23, 255 copies of questionnaires were
sent out and 167 replied copies were qualified for analysis. The replying rate was 74.22%.
Results: For the knowledge of the tooth structure, home care nurses’ was sufficient, but for the knowledge of oral problems caused by diseases and drugs tended to be low, 47.90% and 8.38%, respectively. For scores of the
attitude of“Oral care knowledge”,”Performing oral care skills”, ” Choosing appropriate oral cleaning tools”, ” Providing appropriate oral care equipment”, and ”Choosing appropriate time for oral care” were low. For the Self-efficacy of performing oral care, capacities, onlyy 50% of the home care nurses had confidence to do. For choosing appropriate cleaning tools, 47.90% of home care nurses chose sponge or cotton swabs as cleaning tools,
which are inappropriate for persons with oral structure deficit. This might imply home care nurses lacked of the ability of choosing appropriate cleaning tools. oral education training courses.
Conclusion: From this study, there is much difference of fundamental oral care education among various cohorts of nurses’ education. In order to tie with clinical care situations, the content of the fundamental oral health and care education should be modified and emphasized in nursing school education. In addition, it is necessary to plan more continuous education programs or advanced training programs to enhance home care nurses abilities of oral care. The rate of phenomena is expected to be decreased and the home care quality should be improved as well, if home care cases can receive appropriate care from home care nurses.

並列關鍵字

Home care nurses ； caregiver ； knowledge ； attitudes ； self-efficacy ； caring behavior

參考文獻

1. Haupt BJ (1996). Characteristics of hospice care users: data from the 1996 National Home and Hospice Care Survey. Adv Data.28;(299):1-16.

2. Int J Dent Hyg. 2006 May;4(2):67-71. Oral health status in individuals with dementia living in special facilities.

3. Methods Enzymol. 2008;451:229-39. doi: 10.1016/S0076-6879(08)03216-3. Methods of plate pexophagy monitoring and positive selection for ATG gene cloning in yeasts.

4. Munson ML (1999). Characteristics of elderly home health care users: data from the 1996 National Home and Hospice Care Survey. Adv Data.22;(309):1-11.

5. Sitzman,K.,M.A.,&Bloswick,D.S.(2002).An exploratory study of motor use in home visting nurses.Home Healthcare Nurse,13(2),784-792.