簡易檢索 / 詳目顯示

研究生: 葉淑菀
論文名稱: 養護機構照護者對預防住民跌倒認知、歸因、自我效能與處預方式之探討
指導教授: 郭鐘隆
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2010
畢業學年度: 98
語文別: 中文
論文頁數: 81
中文關鍵詞: 養護機構護理人員照顧服務員處預方式跌倒
英文關鍵詞: Facility, Nurse, Nurse aides, Treatment, fall
論文種類: 學術論文
相關次數: 點閱:1815下載:59
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 跌倒是老年人生活中很值得重視的問題,養護機構住民因整體功能狀況較差,更易面臨跌倒風險。因此,為使住民有安全的環境與妥善的照護,探討機構住民的跌倒問題與養護機構照護者採取之預防措施有其重要意義,亦可作為日後擬訂相關計畫之參考。
    本研究採立意取樣,選取台北縣市地區已立案之11所老人安養護機構,共98位護理人員、本國籍照服員和外籍照服員。以問卷調查方式,探討研究對象之社會人口學變項、認知、歸因、自我效能對處預方式的影響,並與研究對象進行面對面質性訪談,以更進一步了解養護機構照護者實務上的執行情形。
    取得的資料以平均數、標準差、百分比、卡方檢定、獨立樣本t 檢定、變異數分析(analysis of variance)、相關分析 (Correlation Analysis)、階層迴歸分析(Hierarchical Regression Analysis)等方法進行分析。
    本研究主要發現為:研究對象之教育程度越高,及獲證或接受過相關訓練者,認知越高;教育程度越高者,認同歸因越高,本國籍照服員的認同歸因也高於外籍照服員;接受過相關訓練者可預防歸因越高。本研究也發現:認知、可預防歸因是護理人員、本國籍照服員與外籍照服員處預方式的顯著因子;認同歸因、可預防歸因是護理人員和本國籍照服員處預方式的顯著因子;此外,研究對象的可預防歸因越高,在預防住民跌倒時會採取越多相關措施。
    未來在實務工作方面,機構可考慮聘僱教育程度較高、獲證、接受過相關訓練的護理人員與照服員。平時機構可更重視護理人員與照服員的在職教育與訓練課程,增加溝通橋樑,並對高危險群的住民進行相關介入計劃。未來研究者可在本研究的基礎下,更深入探討其他與處預方式相關的因子,或擴大樣本數、地區,或採取護理人員、照服員與住民的配對研究,以更全面地了解護理人員、照服員認知、歸因、自我效能與預防住民跌倒採取處預方式的相關性。

    Residents in the facilities have poor physical functional status. They tend to have the risk of falls. In order to enable to residents have a safe environment and proper care. Preventing fall for residents is worthy of study. The purpose of this study is to explore the relationships among knowledge, attributes, self-efficacy and the process of preventing fall between the nurse and nurse aides. According to the finding of this study, it presents some suggestions as references for improving the preventing residents falling process between nurse and nurse aides and further research in related field.
    There are 98 subjects in the study. They are nurses, the national nurse aides and foreign nurse aides from 11 registered facilities in Taipei. The data in the study is collected by the scale and qualitative interview, and analyzed by Chi-square test, independent samples t-test, analysis of variance, correlation analysis and Hierarchical regression analysis.
    The results of this study are as follows: Education and training are related to the knowledge of nurse and nurse aides; education is related to approval, and the approval of national nurse aides is higher than foreign nurse aides; Training is related to preventable attribution. In addition, in the case of nurses, national nurse aides and foreign nurse aides, knowledge and preventable attribution have significant predictive effect on the process of preventing fall. For nurses and national nurse aides, approval and preventable attribution have significant predictive effect on the process of preventing fall. When having more preventable attribution, they would take more related processes.
    Suggestions for employing nurses and nurse aides with higher education and well-trained, and offering relevant courses are able to prevent residents to fall. In the future researches, increasing the number of subjects and conducting paired-study of subjects and residents should be considered as the focuses of future studies. It could enhance the effect and realize its potential influence and correction of knowledge, attribution, self-efficacy and process of preventing fall.

    第一章 緒論 第一節 研究動機與重要性.....................1 第二節 研究目的.........................4 第三節 待答問題.........................4 第四節 名詞解釋.........................5 第二章 文獻探討 第一節 國內外機構住民之跌倒情形.................8 第二節 養護機構照護者之社會人口學變項對處預方式的影響......9 第三節 養護機構照護者之認知、專業訓練與處預方式的相關性.....12 第四節 養護機構照護者之歸因與處預方式的相關性..........14 第五節 養護機構照護者之自我效能與處預方式的相關性........16 第六節 國內外機構住民跌倒之處預方式 .............. 18 第三章 研究方法 第一節 研究架構.... .................... 28 第二節 研究對象... ..................... 29 第三節 研究工具... ..................... 29 第四節 研究步驟... ..................... 38 第五節 資料處理與分析......................39 第四章 研究結果 第一節 研究對象之社會人口學變項、認知、歸因、自我效能及處預方式的分布情形..42 第二節 研究對象之社會人口學變項對認知、歸因、自我效能的影響...46 第三節 研究對象之認知、歸因、自我效能與處預方式的相關......50 第四節 研究對象之社會人口學變項、認知、歸因、自我效能對處預方式的解釋力..51 第五節 質性訪談.........................53 第五章 討論 第一節 研究對象之社會人口學變項、認知、歸因、自我效能及處預方式.60 第二節 研究對象之社會人口學變項對認知、歸因、自我效能的影響...61 第三節 研究對象之認知、歸因、自我效能對處預方式的影響......63 第四節 研究對象之社會人口學變項、認知、歸因、自我效能對處預方式的解釋力..64 第六章 結論與建議 第一節 研究限制.... .................... 66 第二節 結論... ....................... 66 第三節 研究建議... ..................... 67 參考文獻 中文部分... ........................ 70 英文部分.......................... 75 附錄 附錄一:養護機構照護者對預防住民跌倒認知、歸因、自我效能與處預方式之調查問卷(第一版) 附錄二:養護機構照護者對預防住民跌倒認知、歸因、自我效能與處預方式之調查問卷(第二版) 附錄三:養護機構照護者對預防住民跌倒之訪談題綱(以2008年JCAHO國家病人安全目標擬訂)

    內政部統計通報(無日期)。98年底人口結構分析 。台北市:內政部。民99年5月30日,取自「內政統計資訊服務網」:http://sowf.moi.gov.tw/stat/week/week9904.doc
    古巧琴(2005)。老人照護機構之照護安全相關性研究。中台醫護技術學院醫護管理研究所未出版碩士論文。臺中。
    行政院衛生署(2008)。中華民國97年死因統計(上卷)。台北市:行政院衛生署。
    吳明隆(2007) 。SPSS與統計應用分析。台北市:五南圖書。
    吳淑瓊、江東亮(1995)。台灣地區長期照護的問題與對策。中華公共衛生雜誌。14(3)。246-255。
    李怡娟、吳麗瑜、張麗春、陳俞琪(2005)。充能式教育在長期照護機構的運用—以安養護機構中的外籍照顧服務員為對象。護理雜誌。52(6)。23-28。
    李碧姿、萬育維(2006)。機構外籍監護工服務提供及老人接受服務感受之初探-以臺北市立案養護機構為例。東吳社會工作學報。4。195-138。
    邱泯科、徐伊玲(2005)。老人居家照顧服務員考訓現狀與工作困境之探討。社區發展季刊。110。284-300。
    邱秀霞(2002)。運動員性別類型及成就目標取向對其成敗歸因與情緒影響之研究。國立台灣體育學院體育研究所未出版碩士論文。桃園。
    周志玉(2006)。憂鬱症污名研究:可控制性歸因、危險與依賴刻板印象對歧視行為的影響。中原大學心理學研究所未出版碩士論文。桃園。
    林茂榮、黃慧芬(2008)。老人跌倒之預防介入策略。臺灣公共衛生雜誌。27(6)。447-462。
    林淑芬、高毓秀(2008)。機構高血壓老人預防跌倒行爲相關因素之探討。衛生教育學報。29。99-117。
    梁繼權、湯麗玉、呂碧鴻(1997)。安養機構老人跌倒的前瞻性研究。中華民國家庭醫學雜誌。7。59-68。
    許秋芬(2003)。精神科護理人員照護層面自我效能與關懷行為相關性之研究。臺北醫學大學護理學研究所未出版碩士論文。台北。
    許淑芬(2005)。機構老人跌倒預防課程介入之過程及衝擊評價研究。國立臺灣師範大學衛生教育研究所未出版碩士論文。台北。
    陳秀蓉、李素貞、郭憲文(1998)。台灣中部三縣市長期照顧機構護理人員工作滿意度探討。弘光學報。32。29-45。
    郭林瑋(2003)。老人養護機構運用外籍監護工之效益與困境。社區發展季刊。104。402-413。
    郭鐘隆、張鈞惠、林靜兒、蔡益堅(2009)。16週跌倒預防介入對社區及安養機構老人之成效初探。健康生活與成功老化學刊。1(1)。53-67。
    賀天蕙、葉淑惠、黃夢婷、林麗味(1999)。無約束的長期照護機構。護理雜誌。46(6)。83-88。
    黃子庭(2005)。長期照護老年住民常見的安全問題:虐待、跌倒及營養不良。長期照護雜誌。9(3)。205-212。
    黃惠玲、徐亞瑛(2003)。照顧者訓練方案對改善失智症照顧者能力之探討。長期照護雜誌。7(2)。121-134。
    黃惠璣、李中一(2009)。某市養護機構住民身體被約束之狀況及相關因素之研究。台灣衛誌。28(2)。132-143
    黃儒傑(2002)。國小初任教師教學信念、教學成敗歸因及其有效教學表現之研究。國立高雄師範大學教育研究所未出版博士論文。高雄。
    劉子悌(2006)。機構養護機構照護者老人精神虐待行為之相關因素及教育支持團體介入措施之成效探討。輔英科技大學護理研究所未出版碩士論文。高雄。
    黎家銘、陳晶瑩(2005)。老人跌倒因素的評估與預防。台灣醫學。9(2)。277-284。
    蔡宛容(2008)。機構老人與照顧服務員對口腔衛生的認知、態度、行為調查。國立陽明大學臨床暨社區護理研究所未出版碩士論文。臺北。
    蔡麗珍(2007)。不同屬性照顧服務員工作投入、工作滿足、工作表現相關因素之探討—以中部某教學醫院為例。亞洲大學長期照護研究所未出版碩士論文。台中。
    賴清標(1993)。魏納的歸因理論及其教育含意。初等教育研究集刊,1,77-90。
    謝昌成、蔡坤維、劉鎮嘉(2007)。老年人的跌倒問題。基層醫學。22(10)。352-357。
    熊秉荃、戴玉慈、徐亞瑛、陳月枝、黃久美(1992)。老人長期療養機構護理人員及佐理員之角色與功能。護理雜誌。39(4)。49-55。

    英文部分
    Bagshaw, M., & Adams, M.(1986). Nursing home nurses' attitudes, empathy, and ideologic orientation. Interntional Journal of Aging and Human Development, 22, 235-246.
    Bandura, A.(1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
    Bandura, A.(1997). Self-efficacy: The exercise of control. New York: Freeman.
    Baron, R. A., & Byane, D. (2000). Social Psychology(9th ed)。Boston : Allyn and Bacon.
    Bruyere, O, Wuidart, M.A., Di Palma. E, Gourlay, M., Ethgen, O., Richy, F., Reginster, J. Y.(2005). Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Archives of Physical Medicine and Rehabilitation. 86(2), 303-7.
    Buchner, D.M., Cress, M.E., Lateur, B.J., Esselman, P. C., Margherita, A. J., Price, R., & Wagner, E. W. (1997). The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 52, M218-225.
    Capezuti, E., Evans, L., Strumpf, N.E., & Malislin, G.(1996).Physical restraint use and falls in nursing home residents. Journal of the American Geriatrics Society, 44(6), 627-633.
    Castle, N.G., & Mor,V.(1998). Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987. Medical Care Research and Review: MCRR, 55(2), 139-70.
    Chan, K.M., Pang, W.S., Ee, C.H., Ding, Y.Y., & Choo, P. (1997). Epidemiology of falls among the elderly community dwellers in Singapore. The Singapore Medical Journal, 38, 427-31.
    Chang, J.T., Morton, S.C., & Rubenstein, L.Z., Mojica, W.A., Maglione, M., Suttorp, M. J., Roth, E. A., & Shekelle, P. G. (2004). Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. British Medical Journal, 328, 680-683.
    Chu, L.W., Chi, I., & Chiu, A.Y.(2005). Incidence and predictors of falls in the Chinese elderly. ANNALS Academy of Medicine Singapore, 34, 60-72.
    Chu, L.W., Chiu, A.Y. &Chi, I.(2007). Falls and subsequent health service utilization in community-dwelling Chinese older adults. Archives of Gerontology and Geriatrics, 46, 125-35.
    Goldstein, B., & Rosselli, F. (2003). Etiological paradigms of depression: The relationship between perceived causes, empowerment, treatment preferences, and stigma. Journal of Mental Health, 12(6), 551-563.
    Greubel, Deborah, L., Stokesberry, Carla, Jelley, & Martina J. (2002). Prevention costly falls in long-term care. Nurse Practitioner, 27(3) 83-85.
    Grabiner, M. D, & Jahnigen, D. W. (1992). Modeling recovery from stumbles: preliminary data on variable selection and classification efficacy. Journal of the American Geriatrics Society, 40(9), 910-913.
    Holtzen,V. (1993). Baccalaureate curriculum gerontological nurses objectives. Journal of Gerontological nursing, 19(6), 35-41.
    Howard, E. (1974).The effect of work experience in a nursing home on the attitudes toward death held by nurse aides. Gerontologist, 4, 54-56.
    Huang, T. T. (2005). Home Environmental Hazards Among Community-dwelling older Persons in Taiwan. Journal of Nursing Research, 13(1), 49-57.
    Huang, T. T., & Acton, G. J. (2004). Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders:randomized trial. Public Health Nursing, 21(3), 247-256.
    Ilona Nurmi, & Peter Lüthje .(2002). Incidence and costs of falls and fall injuries among elderly in institutional care. Scandinavian Journal of Primary Health Care. 20(2), 118-122.
    Kallmann, S.L., Denine-Flynn, M., & Blckburn, D.M.(1992). Comfort safety and independence:Restraint release and challenges. Geriatric Nursing, 13(2), 143-148.
    Kannus, P., Sievanen, H., Palvanen, M., Jarvinen, T, & Parkkari, J. (2005). Prevention of falls and consequent injuries in elderly people. Lancet, 366, 1885-1893.
    Kiyoko Izumi, Kiyoko Makimoto, Mayumi Kato, & Tomoko Hiramatsu. (2002). Prospective study of fall risk assessment among institutionalized elderly in Japan. Nursing and Health Sciences, 4(4), 141-147.
    Kohli, N. & Dalal, A. K.(1999). Psychological recovery of women with cervical cancer:The role of cultural beliefs. In Lonner, W. J., Dinnel, D. L., Forgays, D. K., & Hayes, Susanna A(Eds.), Merging past, present, and future in cross-cultural psychology: Selected papers from the Fourteenth International Congress of the International Association for Cross-Cultural Psychology(pp.348-364). Lisse, Netherlands: Swets & Zeitlinger Publishers.
    McKinney, M., & Sexton, T., & Meyerson,M. J. (1998). Validating the Efficacy-Based Change Model. Teaching and Teacher Education, 15, 471-485.
    Parcel, G. S., Swank, P. R., Mariotto, M. J., Bartholomem, L. K., Cyzewski, D. I., Sockrider, M. M., & Seilheimer, D. K. (1994). Self-management of cystic fibrosis : A structural model for education and behavioral variables. Social Science, & Medicine, 38(9), 1307-1315.
    Rubenstein, L. Z.(2006). Falls in older people:epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(2), 37–41.
    Russell, M. A., Hill, K. D., Blackberry, I., Day, L. L., & Dharmage, S. C. (2006). Falls risk and functional decline in older fallers discharged directly from emergency departments. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61, 1090-1095.
    Sattin, R.W., Rodriguez, J.G., DeVito, C.A., & Wingo, P.A. (1998). Home environmental hazards and the risk of fall injury events among community-dwelling older persons. Study to Assess Falls Among the Elderly (SAFE) Group. Journal of the American Geriatrics Society, 46(6), 669-776.
    Sieri, T., & Beretta, G. (2004). Fall risk assessment in very old males and females living in nursing homes. Disability, & Rehabilitation, 26(12), 718-723.
    Stel, V. S., Smit, J. H., Pluijm, S. M. F., & Lips, P. (2004). Consequences of falling in older men and women and risk factors for health service use and functional decline. Age and Aging, 33(1), 58-65.
    Sullivan-Marx, E. M., Strumpf, N. E., Evans, L. K., Baumgarten, M., & Maislin, G.(1999a). Initiation of physical restraint in nursing home residents following restraint reduction efforts. Research in Nursing and Health, 22(5), 369-379.
    Tinetti, M. E, Baker, D.I., McAvay, G., Claus, E. B., Garrett , P., Gottschalk, M., Koch, M. L., Trainor, K., & Horwitz, R. I.(1994). A multifactorial intervention to reduce the risk of falling among elderly people living in the community. The New England Journal of Medicine, 331, 821-827.
    Tinetti, M. E., & Williams, C.S.,(1997). Falls, injuries due to falls, and the risk of admission to a nursing home. The New England Journal of Medicine, 337,1279-84.
    Tinetti, M.E., & Williams, C. S.,(1998). The effect of falls and fall injuries on functioning in community-dwelling older persons. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 53, M112-M119
    Tromp, A.M., Smit, J.H., Deeg, D.J., Bouter, L.M., & Lips, P. (1998). Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. Journal of bone and mineral research, 13(12), 1932-1939.
    Tsang, H. W. H., Tam, P. K. C., & Chan, F. (2003). Stigmatizing attitudes towards individuals with mental illness in Hong Kong: Implications for their recovery. Journal of Community Psychology, 31, 383-396.
    Tzeng, H. M., & Yin, C. Y.(2008). Nurses’ solutions to prevent inpatient falls in hospital patient rooms. Nursing Economics, 26, 179–87.
    Wagnild, G.,& Manning, R.W. (1986). The high-turnover profile, screening and selecting applicants for nurse’s aide. Journal of Long Term Care Administration, 14(2), 2-4.
    Waston, R.(2002). Assessing the need for restraint in older people. Nursing Older People, 14(4), 31-32.
    Weiner, B. (1974). Achievement motivation and attribution theory. Morristown. N. J.: General Learning Press.
    Weiner, B. (1985). An attributional theory of achievement motivation and emotion. Psychological Review, 92(4), 548-573.
    Wyble, S.J., Hanafin, L.F., Brugge-Wiger, P.A.,& Kushkowski, M.A. (1990).A plan for development in gerontological nursing . Journal of Nursing Staff Development, 6 (6), 291-295.

    下載圖示
    QR CODE