以健康信念模式探討某醫院臨床護理人員預防針扎及血液體液暴觸之防治

Abstract

本研究目的係在了解護理人員對防治針扎及血液體液暴觸的健康信念及行為，並探討影響其防治行為的相關因素。研究對象為台北市某區域教學醫院5家綜合院區的臨床護理人員，以自擬式問卷進行調查，發出1,350份問卷，共回收1,090份，其中有效問卷為774份，有效回收率約57%。 研究結果顯示：受訪者以女性居多、未婚、多數具有專科或大學學歷、工作總年資約1-5年，多數曾有針扎或血液體液暴觸經驗，並具有B型肝炎抗體。以健康信念而言，有以下結論：1. 認為若發生針扎或血液體液暴觸事件，因此感染血液傳染病的機會高；2.若因此患病，對自己及家人皆會有影響；3. 認為使用防護具及採取防護措施行為是有助益的；4. 並不認為使用防護具或採取防護措施所面臨的障礙會使其不採取防護措施行為；5. 同意若防治針扎及血液體液暴觸行為的訊息來源多，會促使其願意使用防護具及採取防護措施行為。 依統計方法結果，有以下變項在防治針扎及血液體液暴觸行為具統計的顯著差異：1. 社會人口學變項：「性別」、「年齡」、「有血液體液暴觸經驗」；2. 健康信念變項：「自覺嚴重性認知」、「自覺利益性認知」、「自覺障礙性認知」、及「行動線索」。其中，以「自覺利益性認知」、及「自覺障礙性認知」可做為護理人員使用防護具及採取防護措施行為的預測指標，聯合解釋變異量為10%，以「自覺障礙性認知」最具預測力。 後續相關研究建議可加入「自我效能」變項以增強整體預測力，及「介入措施」以評估其行為改變之成效。本研究僅呈現該區域教學醫院綜合院區護理人員針扎及血液體液暴觸的防治行為現況，無法外推至國內其他醫院之臨床護理人員，但可做為臨床護理人員預防針扎及血液體液暴觸在職教育課程設計與推廣使用防護具及採取防護措施策略之參考。

The aim of the study was to explore the registered nurses’ health belief about the prevention behaviors of needle-stick injury, blood and body fluid exposure. We used the questionnaires and surveyed nurses working in the five branches of Taipei City Hospital. There were 774 effective questionnaires return, and the response rate was about 57%. The results showed: they were most female nurses, single, got the college or baccalaureate degrees, working about 1-5 years in the hospital, had experienced the needle-stick injuries, blood and body fluid injuries, and had the hepatitis B antibodies. They agreed they would tend to get the blood-borne diseases if they got the needle-stick injuries or blood and body fluid exposures, as well as hurt their beloved families badly. They thought it was good to wear protection equipments and to take protective actions. Besides, they disagreed that time-consuming or less efficient were barriers in wearing the protection equipments. If there were more cues to action, it would push them to take the protective actions. The demographic factors such as gender, age, blood and body fluid exposure experience, and health beliefs,”perceived benefits, perceived barriers and cues to action”, were statistically significant in protective behaviors. The predict factors were “perceived benefits”, and “perceived barriers”, however, they only explained 10% of the variance of the preventive behavior. ”Perceived barriers” is the most influential predictor. It is suggested that further studies examine self-efficacy factor, other than health belief. It is also suggested that intervention strategy to strengthen the preventive behavior. The study was not generalizable to nurses working in other hospitals in Taiwan, but it was useful to provide information in designing the nurses’ training programs about the prevention behaviors of the needle-stick injury, blood and body fluid exposure.