護理系學生提供性健康照護的學習需求之研究

護理人員提供臨床個案的性健康照護不足，在養成教育中缺乏將此部分納入課程或訓練是主要的原因。增進護生性健康照護的能力已是護理教育的重要目標。本研究目的主要為了解台灣護理系學生對性健康照護的學習需求，提供性健康照護課程之參考。本研究採立意取樣，進行描述性、橫斷式調查，以中部一所醫學大學護理系，包含四年制與二年制護理系應屆畢業學生為研究對象，填寫結構式問卷「性健康照護學習需要量表」“Learning Needs for Addressing Patients' Sexual Health Concerns” (LNAPSHC)。此研究工具經過內容與建構效度檢測，以及再測信度與內在一致性等信度檢測。研究資料以SPSS 17.0版統計軟體進行統計分析。研究結果發現大學護理系學生在性健康照護有「健康、疾病與性的知識」(sexuality in health and illness)、「與個案討論親密關係的溝通」(communication about patient’s intimate relationships)，以及「提供性健康照護的方法」(approaches to sexual health care)等三層面的學習需求。其中四年制大學護理系學生之學習需求最高(指75%以上的研究對象對於該項的學習需求為中度以上的五個項目包為：治療對性的影響(82.1%)、生命週期與性(80.0%)、病患與伴侶間的相互依賴(77.1%)、疾病、慢性疾病與性(76.4%)，以及性活動的安全、危險徵象及如何因應(75.7%)；研究對象大多認同性健康照護是護理角色之一，但對於提供個案性健康照護的意願不高。與二年制護理系學生相較，四年制護理學生在「健康、疾病與性的知識」(2.19 ± 0.66 vs. 1.80 ± 0.89, P = 0.005)以及「提供性健康照護的方法」(2.03 ± 0.72 vs. 1.76 ± 0.86, P = 0.033)二個層面的學習需求明顯高於二年制護理系學生。大學護理系學生性健康照護因素的影響因素中，有評估個案性功能經驗者在「健康、疾病與性的知識」 (P = 0.001)、「與個案討論親密關係的溝通」(P = 0.031)，與「提供性健康照護的方法」 (P = 0.013)等三層面的學習需求較低；對於性健康照護是護理角色功能認同度較高者，在三層面的學習需求較高(all P < 0.01)；不同學制的護理系學生在性健康照護的學習需求不同，護理教育應依據學生背景提供不同的教育課程。建議四年制護理系學生的課程宜加強健康、疾病與性的知識及提供性健康照護的方法外，強化其對於性健康照護護理角色的正向態度以及加強臨床照護中性健康功能評估的經驗；二年制護理系學生在學校的課程則導入應用型的課程概念，教導在每天的醫療照護情境中納入性健康照護的應用。

關鍵字

學習需求；護理課程；性健康照護；護理系學生

並列摘要

Nurses have revealed low levels of intent to address concerns about sexual health to patients because of insufficient education or training programs. Increase the students’ abilities to confront issues in patients’ sexual health care has been recognized as high priorities in nursing education. Our aims were to determine Taiwanese student nurses' learning needs relative to addressing patients' sexual health concerns, and to gather information for curriculum development in sexual health education. A purposive convenience sample of traditional four-year and RN-BSN undergraduate nursing students was taken from all those enrolled in the senior year in a nursing school at a medical university in central Taiwan. A descriptive, correlational design was used to explore nursing students' learning needs for addressing patients' sexual health issues via self-reported questionnaire, a 24-item instrument entitled “Learning Needs for Addressing Patients' Sexual Health Concerns” (LNAPSHC). The instrument was examined for validity including content validity by expert review and exploratory construct validity by factor analysis as well as for reliability including test-retest reliability and internal consistency. All statistical calculations were performed using SPSS for Windows, version 17.0. Expressed learning needs included: Sexuality in Health and Illness, Communication about Patients' Intimate Relationships, and Approaches to Sexual Health Care. Among four-year nursing students, the five items that showed the greatest learning needs (over 75% response of moderate to strong learning needs) included: “The influences of treatment on sexuality” (82.1%), “Sexuality throughout the life cycle” (80.0%), “Interdependence between patient and sexual partner” (77.1%), “Illness, chronic disease and sexuality” (76.4%), and “Risk and safety in sexual activity and how to respond” (75.7%). Compared to RN-BSN undergraduate nursing students, traditional four-year undergraduate nursing students had more learning needs in the aspects of sexuality in health and illness (2.19 ± 0.66 vs. 1.80 ± 0.89, P = 0.005) and approaches to sexual health care (2.03 ± 0.72 vs. 1.76 ± 0.86, P = 0.033). About the correlation factors of nursing students’ learning needs relative to addressing patients' sexual health concerns, those with experience in assessing patient’s sexual functioning had fewer learning needs in sexuality in health and illness (P = 0.001), communication about patient’s intimate relationships (P = 0.031), and approaches to sexual health care (P = 0.013); those who agreed that sexual health care was a nursing role also expressed greater needs to learn about these 3 aspects (all P < 0.01). Content related to sexuality in health and illness and approaches to sexual health care should be strengthened in the traditional four-year undergraduate nursing curriculum in order to support sexual health related competence, build a positive attitude regarding sexual health care as a nursing role, and strengthen the experience of assessing patient’s sexual functioning. A different, simplified program may be more suitable for those with clinical experience.

並列關鍵字

learning needs ； nursing school curriculum ； sexual health care ； nursing students

參考文獻

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護理系學生提供性健康照護的學習需求之研究

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