緩和療護方案(Palliative Care Program)介入對護理人員知識、態度與照護品質之成效

Effects of Palliative Care Program on Nuurses’ Knowledge and Attitudes and Quality of care

洪麗琴(Lin-Zin Hong)

指導教授 ： 廖玟君

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.2008.00081

摘要

本研究為探討腫瘤病房護理人員接受緩和療護方案後對緩和療護知識、態度、末期照護倫理認同度與照護品質的成效。研究方法為雙組前後測類實驗性設計，採立意取樣，研究對象為中部某醫學中心之腫瘤病房護理人員，研究工具採胡文郁等人（2003）之「安寧緩和照顧知識量表」、「癌末照顧倫理情境」、「對安寧緩和醫療之態度」來評量緩和療護的知識與態度及邱仲峰（2001）所發展之「緩和療護結果量表－醫護人員稽核部份」來評量緩和療護照護品質。實驗組為接受緩和療護方案（給予「安寧入門-醫療專業人員自學教材」之8片CD-ROM的視訊教學共10.5小時，並由研究者針對影片內容設計臨床情境，引導討論、示範、角色扮演、經驗分享、或案例討論等共6小時）之腫瘤病房護理人員22位及另一腫瘤病房護理人員共27位，為對照組，共49位護理人員。以pair T-test及迴歸進行統計分析，統計結果顯示：1）緩和療護方案的介入能增加護理人員緩和療護之知識，並達統計意義（t＝-2.20，p＜.05），其主要預測知識增加之因素為接受緩和療護方案（t＝3.15，p＜.01），其次為接受安寧療護之相關課程或研習會訓練（t＝2.05，p＜.05），總解釋變異量為19.7％；2）實驗組護理人員在緩和療護方案介入後，改變護理人員對緩和療護的正向態度，並有統計差異（正向態度：t＝2.919，p＜.01），其主要預測態度改變的因素為正向態度前測（t＝6.834，p＜.01）及接受緩和療護方案（t＝-2.016，p＝.05），總解釋變異量為47.7％；而在負向態度部份，緩和療護方案的介入可改善護理人員的負向態度（負向態度：t＝2.473，p＜.05），其主要預測態度改變的因素為負向態度前測（t＝5.757，p＜.01）及接受緩和療護方案（t＝2.05，p＜.05），總解釋變異量為45.9％；3）緩和療護方案的介入對倫理認同度（t＝0.081，p＞.05）及照護品質（t＝-1.410，p＞.05），無統計差異。建議未來緩和療護在職教育，應採多媒體教學，並運用討論及角色扮演的教學方式，以提昇腫瘤護理人員對緩和療護的知識及態度。

關鍵字

緩和療護 ； 方案 ； 教育 ； 護理人員 ； 知識 ； 態度 ； 照護品質

並列摘要

The purpose of this study was to evaluate the effects on knowledge, attitudes of nurses and quality of palliative care in oncology ward. This study used qusi-experimental design. Twenty-two nurses were enrolled in a five weeks course of Palliative Care Program (PCP) in the oncology ward of medical center hospital in Taichung. Another twenty-seven nurses were in the control group. Constructed questionnaires including “The Palliative Care Quiz for Nursing (PCQN) Scale ,” “The attitude of palliative care and agreement to palliative ethical issues scale,” and “ The Palliative Care Outcome Scale (POS).” were used to measure nurses’ knowledge and attitudes towards ethical dilemmas and quality of care. These nurses completed all the questionnaires by themselves in pretest and posttest immediately following completion of the PCP. Paired T-test and linear regression were used to examine the effect of the PCP on nurses’ knowledge, attitude and ethical issues toward palliative care and quality of care in terminal patients.
The findings showed that the PCP increased the knowledge（t＝-2.20, p＜.05） and attitudes（Positive attitude: t＝2.92, p＜.01; Negative attitude: t＝2.47, p＜.05 ）of palliative care in oncology nurses. Based on the outcome of stepwise multiple regression, predictors of knowledge of palliative care were received PCP and hospice training. The best predictor was received PCP, the total explained were 19.7％ of the variances in knowledge of palliative care. Otherwise, predictors of positive attitude of palliative care were: pretest of positive attitude and received PCP. The total explained were 47.7％ of the variances in positive attitude of palliative care; the predictors of negative attitude of palliative care were: pretest of negative attitude and received Palliative Care Program. The total explained were 45.9％ of the variances in negative attitude of palliative care.
This research enhanced our understanding of palliative care education. To promote the palliative care education in oncology nurses, further research needs to investigate strategies to increase their palliative knowledge and attitudes and the quality of palliative care.

並列關鍵字

palliative care ； Palliative Care Progra ； attitudes ； quality of palliative care

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