「情緒問題教育課程」對血液透析護理人員照護透析病人情緒障礙和心理問題的知識、態度及行為之成效

Abstract

本研究主要目的在探討「情緒問題教育課程」對血液透析護理人員照護透析病人情緒障礙和心理問題的知識、態度及行為之成效。採類實驗性研究設計（Quasi-experimental designs）及立意取樣，以北部二所醫學中心和一所區域醫學中心之血液透析護理人員為對象，分為實驗組-I、實驗組-II和控制組。以『情緒問題教育課程』為介入性措施，並了解介入性措施之成效。實驗組-I於前測後接受5次、每次60分鐘之課程，實驗組-II於前測後接受一次60分鐘之課程，課程結束後兩組皆予一次後測。控制組施與前後測，沒有接受課程，三組接受前後測時間一致。研究工具為「個人屬性資料表」、「情緒問題知識問卷」、「憂鬱症態度問卷」和「情緒問題照護技巧與執行行為問卷」。前後測共回收共回收有效問卷53份，問卷回收率為61.0%。研究結果歸納如下：（1）三組護理人員在年齡、從事臨床護理工作總年資有顯著差異，亦即實驗組-I護理人員較年長及資深；（2）接觸透析病人心理衛生問題的經驗中，實驗組-I在臨床中有較多接觸精神分裂症病人之經驗；（3）接受心理衛生照護相關教育的時數，以實驗組-I較多；（4）接受情緒問題教育課程前測結果，三組護理人員在知識、態度與行為並無顯著差異；（5）以重複量數變異數分析之混合效果模式，實驗處置為固定效果模式，前測中三組在不同的年齡、工作總年資、是否曾接觸有精神分裂症病人之經驗和心理衛生教育參與時數為控制變項，在知識方面並無顯著差異；（6）在憂鬱症態度，三組後測數值皆較前測上升，顯示護理人員對憂鬱症態度有正向的提升；（7）在情緒問題照護行為方面，年齡每增加一歲，執行照護行為之平均值增加0.51分；（8）以Pearson相關係數分析結果發現出席情緒問題課程次數和知識、態度及行為並無相關性；（9）以Pearson相關係數分析結果發現年齡和照護執行行為有相關。 本研究實驗組I、II與對照組在知識、憂鬱症態度和情緒問題照護執行行為並未有顯著差異，但研究結果與進行過程仍可提供作為未來血液透析室護理人員臨床在職教育之參考。

The major purpose of our study is to explore the effectiveness of the emotional problem education program on the knowledge, attitude, and behavior of the hemodialysis nursing personnel who care the hemodialysis patients with emotional disorders and mental problem. We use the Quasi-experimental designs. Under the purposive sampling, the objects are the hemodialysis nursing care personnel working at two medical centers and one district center in the northern Taiwan. They are classified into three groups: experimental group-I, experimental group-II and control group. We use the Emotional Problem Education Program as intervention tool by which we also try to understand its effectiveness. After the pretest, Exp-I received five 60-minute courses and Exp-II received only one 60-minute course. Then we give the posttest for both groups on the end of education course. The control group does not receive any education program after the pretest. The timing of the pretest and posttest for these three groups tests at the same. Using three questionnaires which are : Individual Basic Data Questionnaire, Emotional Problem Knowledge Questionnaire, Depression Attitude Questionnaire, Emotional Problem Practice Skills and Performance Behavior Questionnaire. The effective questionnaire is 53(response rate 61％). The results shown: (1)There is significant difference on the total working career and age in the three groups, the nursing personnel of Exp-I group are senior. (2)On the aspect of the experience about contact with hemodialysis patients with mental problem, there are much more experiences for Exp-I group to contact the schizophrenic patients. (3)The total hours of mental health education are given more to the Exp-I group. (4)Among 3 groups, there is no significant difference on the pretest result about knowledge, attitude, and behaviors. (5)Analyzed with Repeated Measures as Mixed effects GLMs, experimental intervention is a fixed effect, three groups are in different ages, total work year , look after schizophrenia patient and mental health educate participate in the hours as a covariance, the knowledge shows no significant difference among all three groups. (6)The scores of the posttest on attitude are all increased in three groups. It shows that there is a positive upgrade of the attitude of nursing personnel to the depressive disorders. (7) On the aspect of nursing behavior, the average value of execution of nursing behavior will increase 0.51 score as the increase by one year of age. (8)After the analysis with the Pearson Correlation Coefficient, there is no correlation between the attendance times of emotional problem education and knowledge, attitude or behavior, but the age is related with nursing behavior. According to our study, there is no significant difference in knowledge ，depressive attitude and in behavior of caring about emotional problem, but it’s result and process can be used as a reference tool of continuing education for the hemodialysis nursing personnel.