護理人員照護酒癮病人之壓力因應行為及相關需求

The Study on factors of coping behavior and related issuses of nurses confronting alcoholic patients

洪文林(Wen-Lin Hung)

指導教授 ： 黃崇謙

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2009年)

摘要

研究背景
酒雖然是合法的飲料，因為文化、合法、容易取得等等因素，「飲酒」無形中是國內成人中普遍存在的行為，也因此成為目前台灣社會中最常見物質濫用的問題。
酒精使用疾患求助於急診室、精神科近年來不斷持續地增加，酒精所容易引起的肝腸疾病、神經病變、酒精中毒、精神譫妄等的問題，
甚至有高比率合併焦慮、憂鬱、人格違常、HIV危險行為、其他物質濫用及暴力犯罪等問題；然而護理人員因為工作關係必須經常去面對這類病人的病情變化及人格行為，工作壓力之大不需言喻。
國內文獻中指出，酒癮病人人數持續增加，然而臨床上護理員卻缺少相關酒癮暴力或緊急事件處置等相關教育訓練，護理主管亦不清楚臨床同仁照護酒癮病人時的相關需求，以至於無法適切地提供最適切的行政醫療支援，因此探討護理人員照護酒癮病人之壓力因應行為及相關需求，期能給予臨床行政主管進行參考。

研究目的
　　　　一、探討護理人員基本屬性對於照護酒癮病人壓力之間的關係。
二、分析護理人員在面對酒癮病人時的相關因應行為。
三、探討護理人員照護酒癮病人時的臨床專業需求。

研究方法
　　　　　　本研究採用橫斷式問卷調查方法，選擇台灣地區北部某家精神科專科醫院進行立意抽樣調查，資料收集時間為98年05月10日至98年06月30日，以急診室及精神科所有臨床工作照顧過酒癮病人的護理人員本為研究的資料收集對象，行文至個案醫院通過人體試驗審議委員會(Institution Review Board, IRB)同意後，經多次親自到場解說、補充資料和電話聯絡單位主管，說明研究動機、研究方式及問卷談寫方法說明，並進行問卷回收。

研究結果
　　　　　　研究中發現：
一、 因應行為
　　　護理人員面對壓力仍多採用問題解決因應方式為主，「我會和同事討論找出原因」、「我會藉由進修充實自己的知識不足」、我會常常反覆默念「記取自己的經驗」；而最多採用的負向的情緒因應方式「為我會找人傾訴或抱怨」。而採用問題解決因應方式與護理人員的離職意願基本屬性達顯著性關係；而採用負向的情緒解決因應方式與護理人員的性別、教育程度、婚姻、有無子女、同住子女年紀、合約、進階、工作總年資、單位工作年資、離職意願有顯著關係。　

二、 照顧酒癮病人壓力感受
　　護理人員照護酒癮護理工作措施中，對於「對於酒癮病人出現言語或肢體暴力時，我覺得」、「必須協助酒癮病人打針抽血檢驗時，我覺得」、「照顧酒癮病人神經學症狀時，我覺得」感到壓力最大，其其壓力感受與護理人員的性別、教育程度、婚姻、有無子女、同住子女年紀、合約、職位、進階、工作總年資、單位工作年資、離職意願有顯著關係。

三、 工作特性需求評估：
　　統計中發現「我覺得增加勤務保全人員教育訓練」、「我覺得增加護理人員職前、在職教育訓練」、「我覺得暴力處置教育訓練」措施中，能夠幫助護理人員增加在照護酒癮病人時工作能力及信心，且和和護理人員的與護理人員的婚姻、有無子女、同住子女年紀、合約、進階、工作總年資、單位工作年資、離職意願有顯著關係。未婚、學歷越低、年紀越小、工作年資越淺，越需要單位提供教育訓練。「增加勤務保全人力」、「增加醫護人力」、「成立酒癮專責病
房」、「改善硬體設備（約束器材、房舍等）」措施中能夠幫助護理人員減輕在照護酒癮病人時的工作壓力，和護理人員的與護理人員的
離職意願有顯著關係。

結論與建議
　　　　　本研究總結成果顯示：給予單位足夠的醫療照護人力（包含醫師、護理人員、勤務保全人員等）及提供安全舒適的住院醫療環境建立專屬的藥酒癮病房，如此可以集中有限的醫療資源照護酒癮病
人、提供足夠的醫療照護人力及安全的住院設備，除專業知識外仍需要加強預防暴力防治教育訓練，單位主管應該定期安排練習身心鬆弛技巧、成立照護酒癮病人護理人員支持性團體，同仁可以藉在團體之中可以藉機增加互解，由分享之間得到單位社會性彼此的支持，亦在別人的經驗中增加自我工作經驗、專業知識及增廣見聞。

關鍵字

酒癮 ； 因應行為

並列摘要

Research background
Alcoholic addiction has long been a serious problem.Since the number of alcohol addicts has recently been increasing, their health challenges the nursing staff, with ailments such as alcoholism, the diseases related to the liver, intestines and nerves, consciousness problems accompanied with anxiety, depression, personality disorder, HIV-causing sexual behavior, medicinal abuse and violence. Studies indicate that the population of alcohol abusers increases while clinical nurses lack the relative training about alcoholic violence and emergency. Hence, in this study, we focus on the response and requirements for the nursing staff to take care of the addicted. We hope this study benefits the nursing community as well as administrative managers.
Purpose of research
To analyze and discuss the pressure and responses of the nurses who are taking care of alcohol addicts and the relationship between these two groups. Also, we hope we can come up with a method to enhance the nurses' ability and confidence so that better nursing for the addicts will be achieved.
Research method
Our research is based on a controlled survey from a northernTaiwan psychiatric hospital. The timeline is from 2009 years May 10 to on June 30. The target population of the poll is nursing staff who work in the emergency room and psychiatric department that takes care of the alcohol addicted patients.
Result of research
1. Response
The reaction of the nursing staff to the job pressure is mainly problem-solving, while the others have negative responses. The staff that adopts the former way is based on their education, salary, and service years while the staff adopting the latter is on their education, marriage status and the age of the youngest child whom they live with.
2. Job-pressure when nursing facing alcohol-addicts
The ability of the nursing staff to face alcohol addicts is relative to their working position, whether having young children, and whether having family with alcoholic habit. The nurses experiencing less pressure are the ones who have children of older age, family with drinking habit, or are at a high position.
3. Evaluation of demand
The statistics show that the education level of security guards, the pre-job and on-job education of nurses, and the training to handle violence can enhance nurses' ability and confidence when they are taking care of the patients. Obviously, the nurses' age, education, marital status, work experience, and salary are relative to some attributes. More training is necessary for the nurses who are single, with a lower education level, younger and with a lower salary wage. To relieve the pressure of nurses, it will be helpful if a hospital has more security guards/nursing staff, special wards, and improved equipment.
Conclusion and suggestion
A hospital can provide perfect medical service to the alcohol addicts as long as it has enough medical staff such as doctors, nurses and security guards to provide safe and comfortable environment within the special wards.
The departmental managers should arrange regular training of a relaxing skill, establish a supporting group for alcohol addiction and nursing staff, and form a systematic, fair and effective communication bridge to support the nurses. In this way, nursing staff can enhance self-experience, knowledge and information from others' experience.

並列關鍵字

alcoholism ； coping behavior

參考文獻

林幸魄(1996)．臨床家庭功能性角色之初探，東吳大學社會學研究

及評估．亞洲家庭暴力與性侵害期刊，1（1），163-186。

蔡宗晃、鄭瑞隆、吳岳秀（2005）．男性憂鬱、酒癮及暴力之相關性

巫慧芳、蕭淑貞（1995）．護理人員面對家屬時的工作壓力與壓力因

張惠甄、陳佩英、郭素青(2004)．醫院設立分院時新進護理人員工作