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Effects of Educational Intervention on Nurses' Knowledge, Attitude and Behavioral Intention about Providing Artificial Nutrition and Hydration in Terminal Cancer Patients
No full text本主旨在探討教育介入對改變護理人員提供癌末病患人工營養與水分的知識、態度與行為意向之成效。研究對象為2005年4月至6月，於台北某醫學中心之腸胃內科、一般外科和加護病房內之護理人員。採雙組-前後測之準實驗設計（Quasi-experimental design），以自擬結構式問卷作為評價成效之工具，研究期間共收案88人，控制組和實驗組各44人，實驗組在前測完成後，需參與五十分鐘的教育課程，並於課程結束後兩週進行後測。
結果發現教育介入前，護理人員已具備安寧緩和醫療的基本理念和擁有豐富的實務經驗，但對癌末病患使用人工營養與水分的知識不足，導致雖可感同身受人工營養與水分帶給癌末病患的壞處，但仍傾向繼續提供癌末病患人工營養與水分的負向行為意向。在教育介入後，實驗組之知識、態度和行為意向得分有顯著增加(z=-5.202, p<0.001; t=-4.886, p<0.001; z=-3.274, p<0.001)，其中知識和態度之平均值改變量，在實驗組與控制組間達到顯著差異(t=-7.333, p<0.001; t=-4.063, p<0.001)，表示本教育介入成效良好，但行為意向之平均值改變量，在兩組間並未達顯著之差異(z=-1.943, p>0.05)，這也反應護理人員的行為意向受到其他變項的影響，如醫師和家屬等。研究中有42.9％的護理人員認為「主治醫師或師長」是最具有影響力的人。此外，以逐步線性迴歸分析得知，對人工營養與水分之倫理考量、知識和家屬為影響護理人員行為意向之相對重要因素。
總之，本教育介入之內容對改變護理人員提供癌末病患人工營養與水分的知識和態度具有顯著成效，值得做為學校教育和在職教育之參考。The purpose of this study is to explore the effects of educational intervention on nurses’ knowledge, attitude and behavioral intention about providing artificial nutrition and hydration (ANH) in terminal cancer patients. Pretest-posttest quasi-experimental design was adopted. Structured questionnaires evaluated the effects of educational intervention. From April to June 2005, eighty-eight nurses were enrolled in the gastro-intestinal unit, general surgical unit and intensive care unit of a medical center in Taipei. Participants were randomized into two groups. Each group consisted of forty-four nurses. After the pretest trial, the experimental group participated in a fifty-minute curriculum and received a posttest two weeks later.
The results showed that before the educational intervention, nurses have possessed the basic concept of hospice and were experienced in practice. However, due to the lack of information about providing ANH in terminal cancer patients, the nurses trended toward the negative behavioral intention although they realized the disadvantage of ANH in these patients. After educational intervention, the score of knowledge, attitude and behavioral intention of the experimental group increased obviously (z=-5.202, p<0.001; t=-4.886, p<0.001; z=-3.274, p<0.001). The mean score change of knowledge and attitude between the control and experimental group reached the statistic significance (t=-7.333, p<0.001; t=-4.063, p<0.001) which meant that the educational intervention was effective. However, the mean score change of behavioral intention was not significantly different between these two groups (z=-1.943, p>0.05) which reflected the effects of other variants (such as families, physicians etc.) on nurses’ behavioral intention. Thirty-six of 88 nurses (42.9%) considered that attending physician was the most effective person in this research. Besides, the linear regression statistic analysis exhibited that the ethical concern, knowledge of providing ANH and families were relatively important factors of effecting nurses’ behavioral intention.
Overall, the content of the educational intervention had significant effectiveness in altering the nurses’ knowledge and attitude in providing ANH to terminal cancer patients. It is worth enrolling the concept into the school curriculum and continuing education.誌謝………………………………………………………I
中文摘要…………………………………………………II
英文摘要…………………………………………………III
目錄………………………………………………………IV
圖表目錄…………………………………………………VIII
第壹章 緒論
第一節 研究動機..…………………………………1
第二節 研究目的……………………………………3
第三節 研究假設……………………………………4
第四節 研究架構……………………………………5
第五節 名詞定義……………………………………6
第貳章 文獻查證
第一節 華人之飲食文化觀…………………………7
一、食物之象徵意義……………………………………7
二、華人的飲食文化觀…………………………………7
第二節 正常營養代謝機轉…………………………9
一、飽食期………………………………………………9
二、吸收後期……………………………………………9
三、空腹期………………………………………………10
四、飢餓期………………………………………………10
第三節 癌末病患之營養與水分代謝………………12
一、癌末病患的定義……………………………………12
二、人工營養與水分的定義……………………………12
三、癌末病患之營養代謝………………………………13
四、癌末病患之水分代謝………………………………15
第四節 提供癌末病患人工營養與水分的適切性…17
一、安寧緩和醫療的定義與理念………………………17
二、提供癌末病患人工營養與水分的倫理考量………18
（一）提供人工營養與水分的優點……………………19
（二）提供人工營養與水分的缺點……………………21
第五節 護理人員提供人工營養與水分之重要影響因素…24
一、護理人員之基本屬性………………………………24
二、知識…………………………………………………25
三、態度…………………………………………………25
四、行為意向……………………………………………28
五、主觀規範……………………………………………29
第參章 研究方法
第一節 研究設計 …………………………………32
第二節 研究場所及對象 …………………………33
第三節 研究工具 …………………………………34
第四節 研究工具之信效度 ………………………38
第五節 研究倫理考量 ……………………………42
第六節 資料收集步驟 ……………………………43
第七節 資料分析及方法 …………………………45
第肆章 研究結果
第一節 護理人員對提供癌末病患人工營養與水分的知識、態度
及行為意向之現況分析……………………48
第二節 護理人員對提供癌末病患人工營養與水分之影響
因素………..………………………………54
第三節 教育介入對改變護理人員提供癌末病患人工營養
與水分的知識、態度及行為意向之成效…58
第四節 實驗組之護理人員對教育介入的意見……62
第伍章 討論
第一節 護理教育對護理人員提供癌末病患人工營養與水分的重
要性…………………………………………63
第二節 社會文化對護理人員提供癌末病患人工營養與水分的行
為意向之影響………………………………66
第三節 醫療科層體制對護理人員提供癌末病患人工營養與水分
的影響………………………………………68
第陸章 結論與建議
第一節 結論…………………………………………69
第二節 護理應用與建議……………………………70
第三節 研究限制與未來研究之建議………………71
參考文獻
中文部分…………………………………………………72
英文部分…………………………………………………74
附錄
附錄一 內容效度專家名單………………………………………109
附錄二 專家內容效度檢核………………………………………110
附錄三 問卷專家內容效度檢核結果……………………………112
附錄四 控制組之研究同意書……………………………………118
附錄五 實驗組之研究同意書……………………………………119
附錄六 前測問卷…………………………………………………120
附錄七 控制組後測問卷…………………………………………126
附錄八 實驗組後測問卷…………………………………………13
Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients
No full textEffects of Educational Intervention on Nurses’ Knowledge, Attitudes and Behavioral Intentions toward Supplying Artificial Nutrition and Hydration to Terminal Cancer Patients.
No full text
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Knowledge, Attitudes, and Behavioral Intentions of Nurses Toward Providing Artificial Nutrition and Hydration for Terminal Cancer Patients in Taiwan
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