護理人員安全處理抗癌危害藥品行為之模型分析

Abstract

研究背景：護理人員對工作環境安全風氣感受和使用個人防護裝備感受是影響其採取安全防護措施的常見因素。然而，至今尚未有研究以模型分析方式確認影響護理人員採取安全處理抗癌危害藥品行為的因素。本研究將以偏最小平方法結構方程式驗證預測變項能否解釋和預測護理人員採取安全處理抗癌危害藥品行為，期望研究結果能作為臨床實務、教育訓練、未來研究與政策建置的參考。 研究目的：本研究目的係為以偏最小平方結構方程式驗證護理人員對於工作環境安全風氣感受、個人特性及工作環境特性，與其執行化療藥品靜脈滴注給藥時和處理化療藥品靜脈滴注結束後的點滴瓶(袋)時，採取安全處理抗癌危害藥品行為之間的關聯。 研究方法：本研究採橫斷式研究，以某大學醫學院附設醫院之醫療體系分布於臺灣北部、西北、中南三家院區之護理人員為研究對象，研究者共發出506份問卷，回收484份有效問卷，回收率95.7%。資料收集方式為由研究對象自行填寫研究者自行發展之結構式問卷，問卷包括四個部分：護理人員個人特性及工作環境特性、工作環境安全風氣量表與護理人員採取安全處理抗癌危害藥品行為量表。研究者將484份有效樣本隨機選取約50%，其中的237份進行測量工具探索性因素分析，另外247份資料進行測量工具的驗證性因素分析。經由探索性因素分析確認工作環境安全風氣包含七個構面，且經由驗證性因素分析確認因素結構具可接受的配適度。工作環境安全風氣量表包含七個構面，總計31題，包括臨床照護情境、同儕互相提醒、護理長營造安全工作環境、組織管理者營造安全工作環境、個人防護裝備容易使用、工作場所舒適感受與個人防護裝備穿戴舒適。本研究以247份納入驗證性因素分析樣本以SmartPLS 3.2.8版軟體進行偏最小平方法結構模型分析。 研究結果：描述性統計分析顯示研究對象對於工作環境安全風氣的「組織管理者營造安全工作環境」構面感受程度平均值最高(Mean ± SD: 4.58 ± 0.52)，對於工作環境安全風氣的「個人防護裝備穿戴舒適」構面感受平均值最低(Mean ± SD: 3.24 ± 1.03)。護理人員「執行化療藥品靜脈滴注給藥安全行為」執行頻率整體平均值(Mean ± SD: 4.25 ± 0.84)高於「處理化療藥品靜脈滴注結束後點滴瓶(袋)安全行為」執行頻率整體平均值(Mean ± SD: 2.92 ± 1.22)。以偏最小平方法進行結構模型分析，結果顯示護理人員對工作環境安全風氣感受能解釋29.3%「執行化療藥品靜脈滴注給藥安全行為」，且能解釋30.5%「處理化療藥品靜脈滴注結束後點滴瓶(袋)安全行為」，具有趨近中度的解釋能力，且亦有預測相關能力，整體模式配適度良好。護理人員對工作環境安全風氣感受之「臨床照護情境」、「同儕互相提醒」、「個人防護裝備容易使用」和「個人防護裝備穿戴舒適」和護理人員採取安全處理抗癌危害藥品行為有顯著相關。將護理人員執行化療給藥工作年資、熟悉院內安全處理化療藥品相關作業規範或流程的程度以及化療給藥工作量三項個人特性及工作環境特性納入結構模型分析，結果顯示上述三項變項對其執行化療藥品靜脈滴注給藥安全行為具顯著影響。 建議：本研究建議臨床實務與未來研究可針對工作環境安全風氣之「臨床照護情境」、「同儕互相提醒」、「個人防護裝備容易使用」和「個人防護裝備穿戴舒適」構面，設計介入措施，例如強化護理師對於使用個人防護裝備必要性感受、提供護理師同儕之間分享關於安全處理抗癌危害藥品的看法、引進容易穿戴且穿戴舒適的個人防護裝備並將個人防護裝備放置於工作場域容易取用的區域等。此外，建議可提供多元繼續教育訓練資源、隨時更新技術考試表單，並由提供化療給藥工作年資較為資深護理人員擔任稽核人員定期稽核，以提升護理人員落實安全處理抗癌危害藥品措施的頻率。

Background. Research demonstrates that the nurses’ perceptions regarding workplace safety climate and perception to personal protective equipment use are common factors affecting their compliance with safety precautions. However, to date, no study has empirically examined a structural model to identify the factors related to nurses’ compliance with hazardous drug (HD) safe handling precautions. In this study, we aim to verify whether the ability of predict variables to explain and predict nurses’ compliance with HD safe handling precautions by using partial least squares structural equation modeling (PLS-SEM); the results provide recommendations for nursing clinical practice, education, research, and policy. Aims. This study aims to explore the relationship among nurses’ perception of the workplace safety climate, personal factors, the workplace background, and nurses’ behavior in complying with HD safe handling precautions during the intravenous administration and disconnection of HDs by PLS-SEM. Methods. This study included a cross-sectional survey of nurses recruited in the northern, northwestern, and south-central branches of a university medical system in Taiwan, in which 484 (of 506) self-administrated questionnaires were returned by respondents (response rate, 95.7%). Each participant was asked to complete the structured questionnaire developed by the author. It comprises the following four main parts: nurses’ perception of the workplace safety climate, personal factors, the workplace background, and nurses’ behavior regarding their compliance with HD safe handling precautions during the intravenous administration and disconnection of HDs. The data (N = 484) were randomly split into two groups, one group (N = 237) for exploratory factor analysis, and the other (N = 247) for confirmatory factor analysis. The exploratory factor analysis resulted in seven factors related to the workplace safety climate, and the result of the confirmatory factor analysis verified the acceptability of the model. The seven factors, with 31 items of the workplace safety climate, were “Clinical Care Situation,” “Colleagues Remind Each Other,” “Creation of a Safe Working Environment by the Head Nurse.,” “Creation of a Safe Working Environment by the Organization Manager,” “Ease of Use of Personal Protective Equipment,” “Perception of Comfortable Level of the Workplace,”and “Perception of Comfortable Level of Use of Personal Protective Equipment.” We used the samples (N = 247) for confirmatory factor analysis to verify the model by PLS-SEM 3.2.8. Result. The descriptive statistical results showed that nurses recorded the highest score for the “Creation of a Safe Working Environment by the Organization Manager” (Mean ± SD: 4.58 ± 0.52) of workplace safety climate and lowest for “Perception of Comfortable Level of Use of Personal Protective Equipment” (Mean ± SD: 3.24 ± 1.03). The mean frequency of the nurses’ compliance with HD safe handling precautions during intravenous administration (Mean ± SD: 4.25 ± 0.84) was higher than that during the disconnection of HDs (Mean ± SD: 2.92 ± 1.22). The PLS-SEM analyses revealed that workplace safety climate can explain 29.3% of the variance in nurses’ behavior regarding their compliance with HD safe handling precautions during intravenous administration and 30.5% of the variance during the disconnection of HDs. In addition, workplace safety climate can predict the outcome variable, and the results showed an acceptable model fit. Among the aforementioned variables, the “Clinical Care Situation,” “Colleagues Remind Each Other,” “Ease of Use of Personal Protective Equipment,” and “Perception of Comfortable Level of Use of Personal Protective Equipment” of workplace safety climate were significantly associated with nurses’ behavior regarding their compliance with HD safe handling precautions. We added nurses’ personal factors and the workplace background in the model; the result showed that nurses’ years of experience in administering chemotherapy, familiarity with the policy and procedure for the safe handling of HDs, and chemotherapy workload may significantly affect nurses’ behavior regarding their compliance with HD safe handling precautions during intravenous administration. Suggestions. We suggest that managers of hospitals and researchers should design interventions according to the “Clinical Care Situation,” “Colleagues Remind Each Other,” “Ease of Use of Personal Protective Equipment,” and “Perception of Comfortable Level of Use of Personal Protective Equipment” of workplace safety climate, such as enhancing nurses’ awareness of the importance of personal protective equipment use, creating opportunities for nurses to share with peers their opinions regarding the safe handling of HDs, and purchasing personal protective equipments that are easy to use and comfortable to wear and placing them at optimal locations for easy access. To increase nurses’ frequency of adherence to the HD safe handling precautions, we suggest that hospital managers should provide multifaceted learning resources, update the skills checklist, and invite nurses who are highly experienced in HD handling to conduct regular audits.