教育訓練對護理師之長照2.0政策知識態度與執行成效-以偏鄉某區域醫院為例

背景：台灣人口老化快速已成為高齡國家。政府於2017年開始實施長照2.0政策，擴大對失智、失能老人的照護。偏鄉地區老年人口居多，所能掌握的資源有限，有賴護理師提供相關訊息提供照護。目的：探討教育訓練對偏鄉護理師之長照2.0政策知識態度與執行成效。方法：本研究採類實驗研究設計(Quasi- experimental study design)；以單組介入及重複測量方式進行。於2020年6-9月期間，研究者設計長照2.0政策教育訓練課程，針對偏鄉某區域醫院的臨床護理師為對象，共收案259人。因COVID-19疫情醫院採分艙分流管控，研究者每次以20人以下之小組方式進行教育訓練課程介入60分鐘，使用自擬「護理人員對長照2.0政策知識態度與執行行為問卷」為測量工具，測量時間點為介入前(T1)、介入後即時(T2)、四週(T3)及八週(T4)。採SPSS 20.0版套裝軟體進行統計分析，所使用的統計方法包括描述性統計分析；次數、百分比、平均數及標準差及推論性统計方式；成對t檢定、重複測量及線性迴歸分析。結果：研究結果顯示；偏鄉區域醫院之護理師平均年齡為34.3±7.7，96%為女性，57.9%已婚，平均工作年資為10.37±7.07年，進階層級以N2占41.3%最多。經由長照2.0政策教育訓練課程介入，護理師對長照2.0政策知識於介入後即時(T2)、四週(T3)及八週(T4)均比介入前有顯著進步(p<.05)。護理師對長照2.0政策態度於介入後即時(T2)比介入前有顯著進步(p<.05)，但於第四週及第八週之態度變化比介入前並未達顯著差異(p＞.05)。教育訓練介入後第八週，護理師對長照2.0政策之態度及瞭解病人對長照2.0政策之需求顯著影響其執行行為。結論：藉由教育訓練的介入能提升護理師對長照2.0政策之知識與態度。當護理師對長照2.0政策態度越提升時，護理師的執行行為也相對提升。研究結果能提供臨床在推動長政2.0政策之實務參考，來實現在地老化並提升照護需求。

關鍵字

教育訓練；護理人員；知識；態度；執行；長期照護2.0政策

並列摘要

Background: Due to the rapidly aging population in Taiwan, the government began to implement the Long-Term Care 2.0 Policy in 2017 to expand care for elderly patients with dementia and/or disabilities. Most of the elderly population in rural areas have limited access to healthcare information, thus rely on nurses to provide relevant information related to care. Purpose: This study explored the effectiveness of an education training program on the knowledge, attitude and implementation of the Long-Term Care 2.0 Policy among nurses working at a rural hospital. Methods: Quasi-experimental study design, conducted as a single-group intervention with repeated measures. A self-developed Long-Term Care 2.0 Policy education and training course was delivered to a total of 259 clinical nurses at a regional hospital in a remote township between June and September 2020. Due to the COVID-19 pandemic, the hospital adopted a sub-cabin and diversion control program. Thus, the 60-minute education and training course was delivered to groups of less than 20 nurses at a time. The self-developed "Nursing Staff's Questionnaire on Policy Knowledge, Attitudes and Implementation Behaviors for Long-term Care 2.0" was employed before (T1) and immediately (T2), four weeks (T3) and eight weeks (T4) after the intervention. SPSS version 20.0 was used to calculate frequencies, percentages, averages, standard deviations, paired t-tests, repeated measures and linear regression analysis. Results: The nurses included in this study had an average age of 34.3±7.7; 96% were female, 57.9% were married; 41.3% were employed at the N2 level, and the average number of years’ experience was 10.37±7.07. The education and training course significantly improved (p<.05) the nurses' knowledge of the Long-Term Care 2.0 Policy immediately (T2), four weeks (T3) and eight weeks (T4) after the intervention. Nurses’ attitude towards the Long-Term Care 2.0 Policy was significantly better immediately after the intervention (T2; p<.05 vs. before the intervention), but not four and eight weeks later (p>.05). In the eighth week after the intervention, the nurses’ attitude to the Long-Term Care 2.0 Policy and their understanding of patients’ need for the Long-Term Care 2.0 Policy significantly affected the nurses’ implementation behavior. Conclusion: The education and training intervention improved nurses’ knowledge and attitude towards the Long-Term Care 2.0 Policy, and the improvements in attitude relatively increased the nurses’ Long-Term Care 2.0 Policy implementation behavior. This research provides a practical reference for clinical promotion of the Long-Term Care 2.0 Policy to achieve local improvements in elder care and increase the demand for elder care.