護理人員與癌症病人溝通之自我效能及相關因素探討

The Related Factors on Self-Efficacy of Nurse-Patient Communication during Cancer Care in Taiwan

馮延芬(Yen-Fen Feng 馮 延 芬)

指導教授 ： 李選

中山醫學大學/護理學院/護理研究所/碩士(2008年)

https://doi.org/10.6834/CSMU.2008.00016

摘要

護理人員全日承擔癌末病人的臨床照護責任，其中護病溝通為其每日常規之工作項目，而護病溝通品質之良窳會影響病人之照護結果，亦影響護理人員之專業滿意度。本研究目的即在探討護理人員與癌症病人溝通之自我效能及其相關因素；研究方法採橫斷式相關性研究設計，以中部某醫學中心直接參與癌症照護之護理人員為收案對象，採立意取樣共325位樣本完成有效問卷；研究工具包括Liu等（2007）翻譯修訂的「完成腫瘤專業特定的溝通任務之自信心評價量表」、「溝通結果預期問卷」、「護士感受到的支持問卷」及研究者自擬之「腫瘤護理專業知識量表」。資料分析方法含：百分比、平均值、標準差、t檢定、單因子變異數分析、Mann-Whitney test、 Kruskal Wallis test、相關及線性迴歸等。
研究結果發現：（一）樣本之溝通自我效能、溝通結果預期與感受到對溝通的支持呈正相關；（二）樣本感受到對溝通的支持中，以外在環境的支持得分最低；（三）樣本之溝通自我效能中，以能與憤怒、哭泣、憂鬱、或沈默寡言病患溝通得分最低；（四）溝通自我效能會因樣本年齡、婚姻狀況、教育程度、工作年資、白班照護人數、是否接受過安寧療護課程、同理心與溝通技巧等訓練而有差異；（五）樣本年齡、白班照護病人數、是否接受溝通技巧訓練、自我感受支持程度及溝通結果預期是預測溝通自我效能的重要因子，共可解釋21.9%溝通自我效能變異量。
基於本研究結果，在養成教育方面應將同理心、溝通技巧及安寧療護訓練均列入腫瘤護理人員的先備課程及在職訓練重點；於臨床護理工作方面宜營造能支持護理人員與癌症病人溝通的氛圍；於行政管理方面應安排合理的護理人力及在病房區設立保有隱私且舒適的會談空間；未來研究宜設計整合認知、情意、行為及支持性管理模式之溝通技巧訓練方案，以有效改善及持續強化護病溝通技能，並累積護病溝通的本土性文獻資料。

關鍵字

癌症照護 ； 護病溝通 ； 自我效能 ； 結果預期 ； 感受支持

並列摘要

Background: Nurses are responsible for daily clinical care, and their one principle routine is to communicate with patients. Therefore the quality of communication and the patient–care provider relation can significantly improve health outcomes such as symptom reduction, psychological care, and the professional fulfill.
Objective: To investigate the related factors on self-efficacy of communication during cancer care among Taiwanese nurse.
Methods: A Cross-sectional correlation survey on 325 nurses, who provided direct nursing care for cancer patients, of a medical center by purposive sampling was conducted. The instruments are Nurses’ Self-Efficacy Rating in Oncology Specified Communication Tasks scale (NSROSCT), Communication Outcomes Questionnaire (COQ), and Nurses’ Self-Perceived Support Scale (NSSS) that are translated and modified by Liu J. E. (2007). The other instrument is Oncology Nursing Knowledge Measurement (ONKM) which developed by the researcher.
Data Analysis: Percentage, Means, standard deviations, t-test, one-way ANOVA, Mann-Whitney U, Kruskal Wallis, correlations and linear regression were applied.
Results: (a) Self-efficacy, outcome expectancy and perceived support of nurse-patient communication were significantly positive correlated with each other. (b) The environmental support got the lowest subscore in the perceived support of nurse-patient communication. (c) Communication with angry, crying, depressed and wordless cancer patients got the lowest scores in the self-efficacy of communication. (d) Nurses with different age, marriage, education, work years, number of patients in charge in day shift, hospice training, empathy training and communication skill training possess different self-efficacy of nurse-patient communication. (e) Age, number of patients in day shift, communication skill training, perceived support and outcome expectancy were important factor that can predict self-efficacy of communication and could explain 21.9% variance of self-efficacy.
Expected Implications: The results can be the references (a) To include empathy training, communication skill training and hospice training in the in-service education for oncology nurses. (b) To create supportive atmosphere for nurse-patient communication. (c) To arrange reasonable staffing and a private and comfortable space for interviewing cancer patients. (d)To design a training program of communication skills which integrated cognition, attitude, behavior and supportive management. This program will give the best environment and opportunity for oncology nurses to practice the learned skills. (e) To accumulate local data for nurse-patient communication.

並列關鍵字

cancer care ； nurse-patient communication ； self-efficacy ； outcome expectancy ； perceived support

參考文獻

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