教育介入對改變護理人員提供癌末病患人工營養與水分的知識、態度與行為意向成效之研究

Effects of Educational Intervention on Nurses' Knowledge, Attitude and Behavioral Intention about Providing Artificial Nutrition and Hydration in Terminal Cancer Patients

柯莉珊(Li-Shan Ke)

指導教授 ： 胡文郁

國立臺灣大學/醫學院/護理學研究所/碩士(2005年)

https://doi.org/10.6342/NTU.2005.00890

摘要

本主旨在探討教育介入對改變護理人員提供癌末病患人工營養與水分的知識、態度與行為意向之成效。研究對象為2005年4月至6月，於台北某醫學中心之腸胃內科、一般外科和加護病房內之護理人員。採雙組-前後測之準實驗設計（Quasi-experimental design），以自擬結構式問卷作為評價成效之工具，研究期間共收案88人，控制組和實驗組各44人，實驗組在前測完成後，需參與五十分鐘的教育課程，並於課程結束後兩週進行後測。
結果發現教育介入前，護理人員已具備安寧緩和醫療的基本理念和擁有豐富的實務經驗，但對癌末病患使用人工營養與水分的知識不足，導致雖可感同身受人工營養與水分帶給癌末病患的壞處，但仍傾向繼續提供癌末病患人工營養與水分的負向行為意向。在教育介入後，實驗組之知識、態度和行為意向得分有顯著增加(z=-5.202, p<0.001; t=-4.886, p<0.001; z=-3.274, p<0.001)，其中知識和態度之平均值改變量，在實驗組與控制組間達到顯著差異(t=-7.333, p<0.001; t=-4.063, p<0.001)，表示本教育介入成效良好，但行為意向之平均值改變量，在兩組間並未達顯著之差異(z=-1.943, p>0.05)，這也反應護理人員的行為意向受到其他變項的影響，如醫師和家屬等。研究中有42.9％的護理人員認為「主治醫師或師長」是最具有影響力的人。此外，以逐步線性迴歸分析得知，對人工營養與水分之倫理考量、知識和家屬為影響護理人員行為意向之相對重要因素。
總之，本教育介入之內容對改變護理人員提供癌末病患人工營養與水分的知識和態度具有顯著成效，值得做為學校教育和在職教育之參考。

關鍵字

癌末病患 ； 人工營養與水分 ； 教育介入 ； 知識 ； 態度 ； 行為意向

並列摘要

The purpose of this study is to explore the effects of educational intervention on nurses’ knowledge, attitude and behavioral intention about providing artificial nutrition and hydration (ANH) in terminal cancer patients. Pretest-posttest quasi-experimental design was adopted. Structured questionnaires evaluated the effects of educational intervention. From April to June 2005, eighty-eight nurses were enrolled in the gastro-intestinal unit, general surgical unit and intensive care unit of a medical center in Taipei. Participants were randomized into two groups. Each group consisted of forty-four nurses. After the pretest trial, the experimental group participated in a fifty-minute curriculum and received a posttest two weeks later.
The results showed that before the educational intervention, nurses have possessed the basic concept of hospice and were experienced in practice. However, due to the lack of information about providing ANH in terminal cancer patients, the nurses trended toward the negative behavioral intention although they realized the disadvantage of ANH in these patients. After educational intervention, the score of knowledge, attitude and behavioral intention of the experimental group increased obviously (z=-5.202, p<0.001; t=-4.886, p<0.001; z=-3.274, p<0.001). The mean score change of knowledge and attitude between the control and experimental group reached the statistic significance (t=-7.333, p<0.001; t=-4.063, p<0.001) which meant that the educational intervention was effective. However, the mean score change of behavioral intention was not significantly different between these two groups (z=-1.943, p>0.05) which reflected the effects of other variants (such as families, physicians etc.) on nurses’ behavioral intention. Thirty-six of 88 nurses (42.9%) considered that attending physician was the most effective person in this research. Besides, the linear regression statistic analysis exhibited that the ethical concern, knowledge of providing ANH and families were relatively important factors of effecting nurses’ behavioral intention.
Overall, the content of the educational intervention had significant effectiveness in altering the nurses’ knowledge and attitude in providing ANH to terminal cancer patients. It is worth enrolling the concept into the school curriculum and continuing education.

並列關鍵字

artificial nutrition and hydration (ANH) ； terminal cancer patients ； knowledge ； attitude ； behavioral intention

參考文獻

Singer, P. A. （2003）。臨床生命醫學倫理（蔡甫昌譯）。台北：財團法人醫院評鑑暨醫療品質策進會。（原著出版於2000）

李英芬（2000）。護理人員在癌末病患營養照顧中的角色。安寧療護，5(4)，34-38。

周繡玲（2000）。癌症病人營養問題與照顧需求。安寧療護雜誌，5(4)，50-59。

邱泰源（2001）。癌末患者之緩和醫療。台灣醫學，5(4)，444-448。

邱泰源、胡文郁、蔡甫昌、周玲玲、姚建安、陳慶餘（1998）。緩和醫療照顧的倫理困境。台灣醫學，2(6)，633-639。