臨床護理人員對發燒處置的認識、執行及相關因素探討

Abstract

本研究目的在探討臨床護理人員對發燒處置的認識、執行及相關因素。採描述性研究法，以立意取樣方式，選取台北市某醫學中心的內、外科病房及成人內、外科加護病房共323位護理人員，以自擬的結構式「發燒處置知識與行為問卷」收集資料。將所得資料以描述性統計、t檢定、單因子變異數分析、薛費氏事後比較及皮爾森積差相關檢定進行分析，研究結果如下： 一、發燒處置知識問卷共有19題，滿分為19分，而臨床護理人員平均得分為14.24±2.30分，平均得分未達60％的共有5題，答對率並不理想。影響臨床護理人員發燒處置知識的因素有工作年資及護理進階層級，工作年資愈久者、及護理進階層級愈高者，發燒處置知識得分愈高。 二、臨床護理人員在發燒處置執行之情形及影響因素：在發燒照護中，臨床護理人員常使用發燒處置，其使用頻率由高而低排序為冰枕、解熱劑、及溫水拭浴，影響臨床護理人員使用發燒處置的因素，顯示護理人員在解熱劑使用動機方面，醫師醫囑仍是主要影響因素；而使用冰枕及溫水拭浴的影響因素，主要為護理教育及常識。另由背景資料項目分析所得結果，內科病房的護理人員在解熱劑處置的使用頻率上明顯多於外科加護病房的護理人員；於冰枕處置上，外科病房的護理人員使用冰枕處置之頻率是明顯多於內科病房的護理人員；內科加護病房或外科加護病房的護理人員使用冰枕處置之頻率均明顯多於內科病房的護理人員，且無研讀發燒照護相關之文獻者在使用冰枕處置之頻率是高於有研讀發燒照護相關之文獻者。 三、臨床護理人員在發燒處置認識與執行之相關分析顯示，「發燒處置知識」與「冰枕」呈現低度負相關(r =-0.16)，即發燒處置知識愈高者，其使用冰枕處置的頻率可能稍微偏低，而解熱劑及溫水拭浴二種發燒處置執行頻率與知識無相關。 為了提升臨床護理人員的發燒照護品質，可舉辦發燒照護的在職教育及研討會，落實護理教育，且臨床上應該鼓勵護理人員繼續進階護理層級，促進護理學科的專業發展。而護理人員的常識，在發燒照護行為亦扮演著重要的角色，研究者認為，培養護理人員終生學習的動機、加強文獻閱讀能力，都能讓護理人員的常識，對照護行為有著正向的影響。

The purpose of this study was to explore the knowledge and practices of nurses on fever management and influencing factors. A descriptive cross-sectional research and purposive sampling was conducted in a medical center. Three hundred and twenty three RNs working in medical wards, surgical wards and adult ICUs completed a set of questionnaires developed by the researcher, which regarding knowledge and practices of nurses on fever management. The data were analyzed by descriptive statistics, t-test, one-way ANOVA, Scheffe’s posterior comparison and Pearson’s product moment correlation. The major results were as following: 1. The numbers of questions about nurses’ knowledge of fever management were 19. The mean score of the knowledge of nurses about fever management was 14.24±2.30. There were 5 questions of scores below 60%, which was not as high as expected. Significant factors associated with knowledge scores were working experience and clinical ladder. Nurses who had more working experience and higher clinical ladder had higher scores. 2. The methods of nurses practicing fever management in sequence were ice pillow, antipyretic agent, and tepid sponge. Physician practices strongly influenced nurses’ intentions to administer antipyretic agents. Nursing education and common sense strongly influenced nurses’ intentions to apply ice pillow and tepid sponge for fever management. Nurses working in medical wards administered antipyretic agent for fever management more than nurses in SICUs. Nurses working in surgical wards applied ice pillow for fever management more than nurses in medical wards; nurses working in MICUs or SICUs applied ice pillow for fever management more than nurses in medical wards. Nurses less studying reference about fever management more often applied ice pillow for fever management. 3. The correlation between nurses’ knowledge and practices on fever management revealed that knowledge of fever management was negatively correlated with applying ice pillow (r=-0.16). Nurses with higher level of knowledge on fever management less applied ice pillow to reduce fever. There were no correlation between nurses’ knowledge and the frequency of antipyretic treatment and tepid sponge. In order to increase the quality of nursing practices on fever management, the results of this research suggest that educational program should be developed, implemented and evaluated, and encourage nurses to pursue higher clinical ladder. It is also recommended to develop the lifelong learning motivation and enforce nurses to update the knowledge of fever management. With accurate knowledge and evidence-based intentions, nurses will practice more positively on fever management.