非安寧單位護理人員安寧緩和療護認知、態度之探討

安寧緩和療護理念不僅侷限在癌症末期病人，同時也適用於非癌末患者已是國際潮流趨勢，現況安寧病房的床位明顯不足，因此將安寧緩和療護服務理念擴大至非安寧病房是勢在必行。本論文的研究目的為探討非安寧單位護理人員安寧緩和療護認知與態度現況及需求。以北部某一所醫學中心與二所地區醫院之非安寧單位護理人員為研究對象，研究工具為安寧緩和療護認知、知識、態度量表及基本資料四部分，共收案377位護理人員，有效回收率為67.6%。研究結果顯示非安寧單位護理人員認知得分最高為115分（滿分115分），最低為45分，平均値為83.49±12.71；知識部分得分最高為22分(滿分22分)，最低分為8分，平均得分為17.4±3.20分，平均答對率為79.4%；態度部分得分最高為85分（滿分85分），最低為34分，平均値為66.66±7.74分。整體而言，安寧緩和療護認知程度在中等水準以上，相關的知識狀況頗佳，態度為正向。其中認知與知識部分，護理人員對於安寧緩和療護理念，瞭解醫療團隊合作的重要性，以及自身角色與功能層面，認知程度佳，知識答對率95%以上；對於安寧緩和醫療條例規範相關的法律層面，各種治療的撤除（withdraw）、不予（withhold），呼吸器脫離的情境認知最差，答對率介於38.7%~67.7%。態度部分「必要時，我願意為我的家人簽署DNR」得分最高，最差為「我具備足夠知識來照護接受生命末期緩和療護之病患」。八成五非安寧單位護理人員對於疾病末期，願意主動告知安寧緩和療護理念；然而，297人(78.8%)不願意轉調到安寧病房工作，190人(50.4%)則是拒絕參與安寧療護的志工服務。安寧緩和療護「認知」與「態度」兩者呈中度正相關(r=0.566, p <0.001)；「認知」與「知識」(r=0.001, p >0.05)，以及「態度」與「知識」(r=0.001, p >0.05)無顯著相關。依據本研究結果建議安寧緩和療護應納入護理養成教育課程，在職教育課程能比擬臨床實務情境系統性規劃，可安排交叉訓練及推行安寧共照理念。另外，針對臨床實務困境及倫理議題可藉由多專科團隊會議及實務案例分析討論，以提升護理人員對安寧緩和療護認知及正向態度。

關鍵字

護理人員；安寧緩和療護；認知；知識；態度

並列摘要

It is an international trend to not only include cancer patients at terminal stage with palliative care but also for the non-cancer patients. There are insufficient hospice beds with such a huge demand of palliative care; therefore, it is imperative to extend the concept of palliative care to non-hospice unit. The aim of this study was to explore the perception, knowledge and attitudes toward palliative care among non-palliative care unit nurses. A total sample of 377 nurses with an effective response rate of 67% from non-palliative care units, using a battery of questionnaires related to perception, knowledge, attitude, and demographic information. Results showed that the highest, the lowest and the average score of perception were 115, 45, and 83.49 (total score 115, SD=12.71), respectively. For the knowledge questionnaire, the highest, the lowest and the average score were 22, 8, and 17.4 (total score 22, SD=3.20), respectively with an average of 79.4% correct response rate. Lastly, the highest, the lowest and the average score of attitude were 85, 34, and 66.66 (total score 85, SD=7.74), respectively. In total, the perception of palliative care was above average with a fair level of knowledge and a positive attitude. Regarding perception and knowledge, non-palliative nurses agreed on the concept of palliative care and understood the importance of teamwork, as well as their own roles. These three aspects had 97% and above correct response rate. However, their knowledge toward laws on situations to withdraw or withhold a respirator based on the tenets of palliative care was the worst, had only 38.7~67.7% correct response rate. The highest score of attitude part was that they agree to sign DNR for their family, while the worst was they have enough knowledge on palliative care regarding end of life patients. 85% of non-palliative nurses were willing to take the initiative to inform patients with palliative care concept. However, 78.8% of them didn’t want to transfer to palliative care unit; moreover, 50.4% of them refused to be a volunteer participating in palliative care unit. Findings showed a moderately positive correlation between perception and attitude (r=0.566, p <0.001). While, there were no correlation between perception and knowledge (r=0.001, p >0.05) as well as knowledge and attitude (r=0.001, p >0.05). This study suggested palliative care should be integrated into the training course of nurses and to have a systematic plan of integrating palliative into clinical practice and thus the concept of palliative can be implemented into nursing care. Moreover, interdisciplinary meetings and discussions of clinical case studies and ethical issues can enhance awareness and attitude of nurses towards palliative care.