腫瘤護理人員靈性安適及其相關因素探討

Abstract

研究背景：根據我國衛生福利部統計，惡性腫瘤蟬聯第41年為十大死因之首，即便近年新冠肺炎（Coronavirus disease 2019, COVID-19）影響仍不足以撼動，足以顯示目前惡性腫瘤對人類生命的巨大影響。隨著醫療科技的進步，興新療法讓腫瘤治療愈來愈多元化，使腫瘤護理人員面對新知學習的壓力、高風險的工作環境、人力不足與腫瘤照護複雜的身心問題、面對病人和家屬、醫療團隊間之溝通造成更多挑戰，皆可能影響腫瘤護理人員工作負荷、疲倦、情緒，進而影響其靈性安適狀況。 研究目的：旨探討腫瘤護理人員身心狀況（工作負荷感受、疲憊感受、情緒困擾程度）、一般性自我效能、溝通能力與靈性安適感之現況與疫情中、疫情後其身心狀況、一般性自我效能、溝通能力與靈性安適感等變項之差異性，同時，探討各變項間之相關性並確認靈性安適感的影響因素。 研究方法：本研究採橫斷式之研究設計，於全國各層級之腫瘤科相關專科的醫療院所進行收案，使用之問卷工具含：工作負荷感受量表、疲憊感受量表、情緒困擾溫度計、一般性自我效能感量表、溝通能力量表與靈性安適感量表，運用Pearson相關分析、獨立樣本T檢定及線性迴歸分析分別來分析各變項間的相關、疫情中後的差異性及安適感的影響因素。 結果：本研究收錄共93位腫瘤護理人員，其工作負荷、疲憊感受及情緒困擾都達中等程度之嚴重度，一般性自我效能、溝通能力及靈性安適表現為中等程度，並且疫情中與疫情後兩組於各變項間並無統計上顯著之差異。研究進一步發現與靈性安適有相關性的變項包括工作負荷（r=-0.213，p<0.05）、疲憊感受（r=-0.380，p<0.01）、情緒困擾（r=-0.435，p<0.01）、一般性自我效能（r=0.490，p<0.01）與溝通能力（r=0.425，p<0.01），但能預測的變項主要是情緒困擾、一般性自我效能與溝通能力，整體解釋變異量為40.8%。 結論：本研究結果發現腫瘤護理人員目前正面臨中度以上之工作負荷、疲憊與情緒困擾，而其一般性自我效能與靈性安適狀況僅達中度程度，且疫情過後，這些狀況並未改善，因此，建議未來針對本研究發現之重要影響靈性安適感的情緒困擾進行緩解介入方案、一般性自我效能與溝通能力提升之教育訓練，將對靈性安適提升有正面的影響。

Background: According to statistics from the Ministry of Health and Welfare in Taiwan, malignant tumors have consistently ranked as the leading cause of death for 41 consecutive years. Even with the recent impact of Coronavirus Disease 2019 (COVID-19), it has not been enough to overshadow the profound impact of malignant tumors on human life. With advancements in medical technology, emerging therapies have diversified tumor treatments, placing oncology nurses under pressure to acquire new knowledge, work in high-risk environments, cope with understaffing, and address the complex physical and psychological issues associated with tumor care. Challenges in communication among patients, their families, and healthcare teams further contribute to the burden on oncology care professionals, potentially affecting their workloads, fatigue, psychological distress, and subsequently, their spiritual well-being. Purpose: This study aims to investigate the current status and correlations of oncology nurses' physical and psychological status (perceived workload, fatigue, and psychological distress), general self-efficacy, communication skills ability, and spiritual well-being. The study also explored the differences in these variables during and after the pandemic and identified the influencing factors. Methods: A cross-sectional research design was adopted for this study. Participants were recruited from medical institutions at various levels, including those specializing in oncology. The questionnaire included instruments such as the Perceived Workload Scale, Fatigue Perception Scale, Emotional Distress Thermometer, General Self-Efficacy Scale, Communication Skills Ability Scale, and Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being. Pearson correlation analysis, independent sample t-tests and linear regression analysis were used to analyze the relationships between variables, differences in variables before and after the pandemic, and the factors influencing well-being. Results: A total of 93 oncology nurses participated in the study. The perceived workload, fatigue, and psychological distress were all at a moderate severity level. General self-efficacy, communication skills ability, and spiritual well-being were moderately expressed. There were no statistically significant differences between the two groups in terms of variables during and after the pandemic. The study further revealed that variables related to spiritual well-being included workload (r=-0.213, p<0.05), fatigue (r=-0.380, p<0.01), psychological distress (r=-0.435, p<0.01), general self-efficacy (r=0.490, p<0.01), and communication skills ability (r=0.425, p<0.01). However, the predictive variables were primarily psychological distress, general self-efficacy, and communication skills ability, explaining 40.8% of the variance. Conclusion: The study findings indicate that oncology nurses currently face a moderate to high workload, fatigue, and psychological distress. Their general self-efficacy and spiritual well-being are only at a moderate level, and these conditions did not improve after the pandemic. Therefore, it is recommended that future interventions focus on alleviating psychological distress, enhancing general self-efficacy, and improving communication skills based on the identified influential factors. These interventions are likely to have a positive impact on spiritual well-being.