護理師執行癌症病人性健康照護的經驗與影響因素

Abstract

研究背景：癌症及其治療常造成性功能與生殖能力受損，進而影響病人身心適應與生活品質。儘管性健康在癌症整合照護中扮演重要角色，然而超過半數病人從未與醫療人員討論性相關問題，研究顯示病人可能因文化禁忌、羞怯或擔心被誤解，而難以主動表達其性健康困擾；相對地，護理人員可能因角色定位不明確、缺乏相關經驗與教育訓練，或受限於對性議題的刻板印象，而未主動介入提供適切的性健康照護。然而在東方文化脈絡下，針對護理師提供癌症病人性健康照護之經驗、角色認同及其影響因素的研究仍有限，顯示此議題亟需進一步深入探討。 研究目的：本研究旨在：（1）瞭解腫瘤護理師提供癌症病人性健康照護之感受與經驗；（2）瞭解腫瘤護理師提供癌症病人性健康照護之角色認同歷程；（3）驗證中文版「性健康照護態度量表（Sexual Health Care Scale-Attitude, SHC-A）」、「性健康照護知識量表（Sexual Health Care Scale-Knowledge, SHC-K）」與「性健康照護實務量表（Sexual Health Care Scale-Practice, SHC-P）」之信度與效度；（4）瞭解腫瘤護理師提供癌症病人性健康照護之態度、知識與實務執行現況；（5）探討影響腫瘤護理師執行癌症病人性健康照護實務之相關因素。 研究方法：採質性及量性研究方法設計，旨在透過質性與量性之不同視角，全面探討護理師提供性健康照護之行為。質性部分透過立意取樣，招募20位具腫瘤照護經驗之護理師進行深度訪談，並參考現象學分析步驟，整理歸納護理師提供癌症病人性健康照護之經驗與角色認同相關主題。量性部分採橫斷性研究設計，以方便取樣招募182位護理人員填寫中文版SHC-A、SHC-K與SHC-P量表。量表驗證以探索性因素分析、Cronbach’s α係數、組內相關係數（Intraclass Correlation Coefficient, ICC）、及Rasch模型分析，以驗證量表之信效度；最後透過多元線性迴歸分析，探討影響護理師執行性健康照護實務之相關因子。 研究結果：質性研究結果顯示，腫瘤護理師提供癌症病人性健康照護/諮詢的歷程，可歸納出「角色認同轉化」的核心主題；此核心主題包含四個主題，分別為「角色拒絕」、「角色挑戰與掙扎」、「角色在學習中建構」以及「角色執行」，反映護理師於性健康照護/諮詢情境中，其角色認同隨經驗累積與情境互動而轉化的經歷。量性結果顯示，SHC-K 經 Rasch 模型分析顯示題項適配度良好，具備單向性特質；SHC-A 與 SHC-P 量表經探索性因素分析，分別萃取四個因子與兩個因子，解釋變異量為 64.41% 與 73.57%；SHC-A （Cronbach's α 係數： 0.88）與 SHC-P（Cronbach's α 係數：0.99） 兩份量表皆具優異的內在一致性信度。護理師 SHC-A、SHC-K 與 SHC-P 的平均得分分別為32.9分（總分51分）、43.82 分（總分 55 分）及 6.51 項（總分21項）。多元線性迴歸分析指出，擔任個案管理師（β＝3.57；p < .001）及研究護理師/專科護理師（β＝3.74；p = .001）之護理角色，其執行性健康照護實務頻率顯著較高；此外，護理師之「討論性議題的心理舒適度」（β＝0.21；p= .02）與性健康「生理層面」認知（β＝0.32；p= .02），與執行性健康照護實務頻率呈現顯著正相關。 結論與臨床應用：腫瘤護理師提供癌症病人性健康照護/諮詢的經驗，呈現「角色認同轉化」的現象，涵蓋「角色拒絕」、「角色挑戰與掙扎」、「角色在學習中建構」與「角色執行」的角色認同歷程。個案管理師、研究護理師/專科護理師等護理角色、具備較高「討論性議題心理舒適度」與性健康「生理層面」知識，可預測較高性健康照護實務執行頻率。顯示腫瘤護理師執行性健康照護不僅涉及態度與知識能力，也與護理師對於性健康照護的專業角色認同密切相關。為促進腫瘤護理師提供性健康照護實務，建議運用本研究驗證之中文版 SHC-A、SHC-K 與 SHC-P 量表，評估腫瘤護理師性健康照護態度、知識與實務表現，並作為追蹤教育介入成效之客觀指標。此外，建議因應護理師提供性健康照護角色認同經歷，設計個別化教育訓練計畫，並於制度層面建立結構化的支持機制與明確的角色定位，以營造有利於執行性健康照護的環境，進而促進性健康照護落實於護理照護實務中。

Background: Cancer and its treatments often impair sexual function and reproductive capacity, consequently affecting patients’ psychosocial adjustment and quality of life. Although sexual health is recognized as an essential component of comprehensive cancer care, studies have shown that more than half of patients have never discussed sexual concerns with healthcare professionals. In clinical practice, patients may hesitate to express sexual health concerns due to cultural taboos, embarrassment, or fear of being misunderstood. Conversely, nurses may refrain from addressing sexual health because of unclear professional role boundaries, limited experience or training, or stereotypical perceptions of sexual issues. However, within Eastern cultural contexts, research examining nurses’ subjective experiences, role identity, and associated factors in providing sexual health care for cancer patients remains limited, indicating a need for further investigation. Objectives: This study aimed to: (1) describe nurses’ experiences in providing sexual health care for cancer patients; (2) explore the experiences/process of role identity development in providing sexual health care for cancer patients; (3) examine the reliability and validity of the Taiwan versions of the Sexual Health Care Scale–Attitude (SHC-A), Sexual Health Care Scale–Knowledge (SHC-K), and Sexual Health Care Scale–Practice (SHC-P); (4) explore nurses’ attitudes, knowledge, and practice regarding sexual health care for cancer patients; and (5) identify factors associated with providing sexual health care for cancer patients. Methods: The qualitative and quantitative methods design was adopted to examine nurses' sexual health care practices from distinct perspectives. In the qualitative component, purposive sampling was used to recruit 20 oncology nurses for in-depth interviews, and data were analyzed following phenomenological analytic principles to identify themes related to their experiences and role identity in providing sexual health care. In the quantitative component, a cross-sectional design with convenience sampling was used to recruit 182 nurses to complete the SHC-A, SHC-K, and SHC-P scales. Scale validation included exploratory factor analysis, Cronbach’s alpha, intraclass correlation coefficients (ICC), and Rasch model analysis. Multiple linear regression analysis was conducted to examine factors associated with sexual health care practice. Results: Qualitative findings revealed that oncology nurses’ experiences in providing sexual health care or counseling could be conceptualized as a core theme of Role Identity Transformation. Four themes were identified: “role rejection,” “role challenge and struggle,” “role construction through learning,” and “role performance.” These themes reflected a process in which nurses’ professional role identity evolved through accumulated experience and interaction within sexual health care contexts. Quantitative results from Rasch analysis demonstrated that the SHC-K exhibited good item fit and unidimensionality. Exploratory factor analysis extracted four factors for the SHC-A and two for the SHC-P, accounting for 64.41% and 73.57% of the total variance, respectively. Both the SHC-A (Cronbach’s α = 0.88) and SHC-P (Cronbach’s α = 0.99) demonstrated excellent internal consistency. Mean scores were 32.9 (out of 51) for SHC-A, 43.82 (out of 55) for SHC-K, and 6.51 (out of 21) for SHC-P. Multiple linear regression analysis revealed that nursing roles, specifically case managers (β = 3.57, p < .001) and research nurses/nurse practitioners (β = 3.74, p = .001), were significantly associated with higher frequencies of sexual health care practice. Additionally, greater psychological comfort in discussing sexual issues (β = 0.21, p = .02) and higher levels of physiological knowledge of sexual health (β = 0.32, p = .02) significantly predicted more frequent sexual health care practice. Conclusion and Clinical Implications: Oncology nurses’ experiences in providing sexual health care for cancer patients reflect a process of professional role identity transformation, encompassing “role rejection”, “role challenge and struggle”, “role construction through learning”, and “role performance”. Nursing roles, including case managers and research nurses/nurse practitioners, as well as comfort in discussing sexual issues and knowledge of sexual health physiology, were significantly associated with sexual health care practices. These findings highlight that sexual health care is not merely a matter of technical competence or knowledge, but is also intrinsically linked to professional role identity. The validated Taiwanese versions of the SHC-A, SHC-K, and SHC-P can serve as evidence-based instruments for assessing nurses’ attitudes, knowledge, and clinical practices, as well as indicators for evaluating the effectiveness of educational interventions. To facilitate the implementation of sexual health care in clinical practice, educational and institutional support strategies should be tailored to nurses’ role identity process, supported by structured mechanisms and clear role delineation.