醫院護理人員對住院病人提供口腔照護相關知識、態度、自我效能、及行為之探討

研究背景：系統性疾病住院病患易因疾病的複雜性、長期住院、及本身專注於系統性疾病本身造成口腔衛生的忽略。而口腔護理主要目的在幫助病患維持口腔清潔與舒適，有效的口腔護理可增進病人口腔舒適及預防嚴重感染，是全人照顧的一部分。雖然提供病人口腔衛生是基礎護理實務，但病房護理人員在執行住院病人口腔照護卻是一大挑戰。研究目的：本研究在探討臨床護理人員對住院病人口腔保健相關知識度及提供照護行為、自我效能影響因素之現況。希望藉此研究，瞭解病房護理人員執行病人口腔護理的方式，及其對口腔護理的知識與態度，作為擬定以實證為依據的病患口腔護理規範，以及提供護理人員執行病人口腔護理相關在職教育之依據。研究方法：本研究以自擬的結構性問卷，以南部地區42家醫院為研究對象。收集內科、外科、婦產科、兒科、加護病房共80個病房，2000位護理人員對病人口腔護理的知識、態度與執行方式等問卷資料。內容包括：(一)研究對象背景資料分佈情形；(二)口腔保健知識、態度、自我效能得分情形；(三)研究對象提供住院病患口腔保健行為的現況；(四)背景資料與口腔保健知識、態度、自我效能及行為的關係；(五)口腔保健知識、態度、自我效能與行為的相關性；(六)研究對象提供住院病患口腔保健行為的預測因子。研究結果：寄出2000份問卷。共蒐集 1752份有效問卷，進行資料收集後的統計分析，護理人員的口腔保健知識得分越高，其口腔護理相關措施執行頻率越高。病房資深護理人員的指導是護理人員學習病患口腔護理之主要來源。護理人員學習病患口腔護理的來源方式會影響護理人員對病患口腔護理知識的瞭解程度、態度意向與口腔護理相關措施理想執行頻率；且護理人員學習病患口腔護理來源數越多，其對病患口腔護理的知識越瞭解、態度越正向。護理人員年齡越年長，其對病患口腔護理相關措施理想執行頻率越高；加護病房護理人員比內科、外科、婦產科、兒科病房護理人員，在口腔護理相關措施執行上有較頻繁的理想執行頻率。結論與建議：本研究建議護理人員藉由多元化的學習資源及持讀性的終身學習來獲得口腔保健相關知識，以提昇護理人員對口腔保健的知識與態度；另外以病房為中心進行相關在職教育訓練，期望提昇住院病患口腔照護的品質。

關鍵字

口腔保健知識；口腔保健態度；口腔保健執行方式；口腔保健自我效能

並列摘要

Background The major object of oral care, a part of holistic care, is to maintain oral hygiene, prevent wound infection and offer comfort environment for patients. Oral care is a primary care to provide oral hygiene to patients and mainly practiced by nurses in the wards, their knowledge, attitude, self-efficacy, and practice toward oral hygiene care is very important to the ward patients with systemic diseases. Purpose Objectives The object of this study is to evaluate the knowledge, oral care practice and self-efficacy factors of clinical nurses to oral hygiene of ward patients. Methods This study was a cross-sectional study. A structuralized questionnaire concerning about the knowledge, attitude, self-efficacy, and practice of oral hygiene care to ward patients with systemic diseases were sent to a total number of 2000 nurses who are serving in the 42 hospitals of southern Taiwan which included two of five medical centers, five of fourteen regional hospitals, and nine of 23 district teaching hospitals in southern Taiwan. This program was conducted from Sep. 2009-Feb. 2010 under complete explanation to the nurses who have signed the agreement and consent to this program. There are six parts of the questionnaire included: (1)The background distribution of nurses. (2)The score distribution of knowledge, attitude, and self-efficacy of nurses toward the oral hygiene care. (3) The situation of the behavior of nurses toward oral hygiene care for admitting patients. (4)The relation between nurses’ background and knowledge, attitude, self-efficacy and behavior of nurses toward the oral hygiene care. (5)The relation between knowledge, attitude, self-efficacy and behavior of oral hygiene care. (6)The prediction factors of the behavior of nurses toward oral hygiene care for admitting patients. Statistical methodology included descriptive statistics, t-Test, Chi-square test, ANOVA and linear/logistic regression analyze. Results There were 1752 valid questionnaires, including knowledge, attitude and execution of oral care of nurses for wards patients, returned from nurses of 80 units including medicine, surgery, obstetrics and gynecology, pediatrics, and intensive care units of 42 hospitals in total. The knowledge score of oral hygiene care of nurses were not so high; they did not practice the oral hygiene care to the ward patients very often. The nurses in intensive care units practiced oral hygiene care more often than those done in other wards. The nurses with higher score of knowledge of oral hygiene care had statistically significantly more positive attitude and practice of oral hygiene care to patients. The primary resources toward oral hygiene care of nurses were instructed by senior nurses rather than dentists. Conclusion and Suggestion This study shows the higher score of knowledge of nurses toward the oral hygiene care the more execution of oral hygiene care. The nurses primarily learn the knowledge of oral hygiene care from senior’s instructors rather than dentists, dentists. And the knowledge of oral hygiene care will affect the attitude, practice and executive frequency of relevance activities. The higher score and more sources of knowledge concerning oral hygiene care the nurses learned, the more positive attitude and activities of oral hygiene care to patients. The senior of nurses provided more often oral hygiene care. The nurses in intensive care units execute oral hygiene care more often than those who were in medicine, surgery, obstetrics and gynecology, pediatrics wards. The relevant knowledge of oral hygiene care of nurses should be reinforced and upgraded by multiple learning resources, continuous education concerning about oral hygiene care and hand-on practical training courses for the on-the-job nurses constantly and frequently to improve the knowledge, attitude and practice of oral hygiene care for wards patients, and then enhance the quality of oral care of admitting wards patients.

並列關鍵字

knowledge ； attitude ； self-efficacy ； oral hygiene ； nurse ； ward patients with systemic diseases ； practice ； execution ； self-efficacy of oral hygiene