護理人員照護癌末病患身心困擾及相關因子探討

The Related Factors on Psycho-physical Distress during Care of Terminal Cancer Patients of Clinical Nurses

李美芬(Mei-Fen Lee)

指導教授 ： 李選

中山醫學大學/護理學院/護理學系碩士班/碩士(2010年)

摘要

本研究目的在探討護理人員照護癌末病患身心困擾，採相關性研究之結構式問卷調查，立意取樣，抽樣條件以中部某醫學中心及某區域教學醫院具有護理師或護士執照，近半年直接照顧癌症病患之臨床護理人員達三個月以上者，且一週內直接參與癌末照護，共119位護理人員參與此研究，研究工具為自擬之「護理人員照護癌末病患身心困擾問卷」共22題，其內容效度指標為.89~.90，內在一致性Cronbach’s α值為0.956~0.972。
本研究以SPSS/14.0，進行描述性及推論性統計，再以單因數子變異分析、皮爾森相關檢定檢視各變項間之關係，最後以強迫進入回歸分析預估其重要影響因素。結果發現：樣本身心困擾總平均分數是65.4 ± 21.4分，照護癌末病患感到身心困擾的程度前五名是擔心針扎、化療及放射線治療會影響個人安全；當癌末病患未簽署DNR時，工作上會感到緊張；與癌末病人或家屬討論病情感到不自在；在癌末護理工作中覺得無助；癌末病患的護理工作不易入睡或睡不穩。
教育程度愈高、資深、專業進階職級愈高、固定班別、參加過相關專科訓練及在安寧病房工作之護理人員有較低的身心困擾，經統計調整後，得知專業進階制度及相關專科訓練為重要影響因子；研究建議：實務方面，應重視腫瘤科病房護理人員身心困擾議題，針對高身心困擾得分項目作實務改善，建立化學治療、放射線治療及針扎標準流程；護理教育方面，腫瘤護理交叉訓練可考慮在一般病房優先施行，以期達到護理人員照護癌末病患之全面品質提升。

關鍵字

身心困擾 ； 癌末病人 ； 護理人員

並列摘要

This study aims to explore the psycho-physical distress during care of terminal cancer patients of clinical nurses. It was based on a cross-sectional correlation survey and purposive sampling was conducted. The samples were one hundred and nineteen registered nurses who within the last six months had cared for terminal cancer patients for more than three months, and were still caring for terminal cancer patients for at least one week before the survey was conducted. These nurses worked either in a medical center or regional teaching hospital, situated in central Taiwan. The questionnaire titled “Psycho-physical Distress of Clinical Nurses during Care of Terminal Cancer Patients” consists of 22 questions. The content validity of which is .89~.90, with the internal consistency reliability of the Cronbach’s α value 0.956~0.972.
First, SPSS/14.0 was used for both the descriptive and inferential statistics. Then one-way ANOVA and Pearson correlation were used to analyze the correlation of the variables. Finally, forced-enter regression analysis was used to determine the factors which might influence the nurses’ psycho-physical distress. The result showed that the average score of psycho-physical distress in these nurses was 65.4 ± 21.4. It also indicated that the top five factors which influenced the nurses’ psycho-physical distress were: 1) Fear of getting pricked by needles, or being exposed to chemical agent or radiation during chemotherapy and radiotherapy. 2) Feeling of stress and nervous caused by terminal cancer patients not signing a DNR. 3) Uneasiness when discussing the patient’s condition with their family. 4) Feeling of helplessness while caring for the terminal cancer patients. 5) Poor sleep quality while caring for the terminal cancer patients.
The result also indicated that those who have a higher educational background, more clinical experience, a higher ranking, a fixed shift or have received related trainings have relatively lower psycho-physical stress. After adjusting the confounders, it was concluded that ranking system and professional trainings were two important factors.
It is suggested that the psycho-physical distress of those who work in an oncology ward should be seriously taken into account. The factors which caused higher distress should be alleviated. Establishing a standard operating procedure for chemotherapy, radiotherapy and accidental needle pricks would be necessary. As for nursing education, the cross-training of oncologic nursing care program should be initiated in general wards first in order to improve the quality of caring for cancer patients.

並列關鍵字

Psycho-physical distress ； terminal cancer patient ； nurse

參考文獻

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