腫瘤護理人員溝通能力及其相關因素之探討

Abstract

研究背景：腫瘤護理人員是第一線面對癌症病人因疾病本身、治療副作用和疾病復發或進展而導致情緒困擾的專業人員，腫瘤護理人員的溝通能力是評估與支持癌症病人情緒困擾的重要技能。然而，後疫情世代，腫瘤護理人員溝通能力及相關因素探討的研究仍十分有限，故本研究致力於深入探討這方面的議題。 研究目的：（1）探討腫瘤護理人員溝通能力現況、（2）探討腫瘤護理人員身心負荷、自我效能（一般性自我效能、心理腫瘤照護自信心）、同理心與溝通能力相關性、（3）探討癌症病人感受到腫瘤護理人員的溝通能力、同理心、滿意度現況、（4）探討癌症病人感受到的溝通能力、同理心、溝意度與腫瘤護理人員之身心負荷、自我效能、同理心與溝通能力之間相關性、（5）確認影響腫瘤護理人員溝通能力重要因子。 研究方法：採橫斷式研究，立意取樣於北部某醫學中心腫瘤病房收案，護理人員資料含基本資料、身心負荷、自我效能、同理心及溝通能力；病人資料含基本資料、溝通能力、同理心及滿意度。主要以斯皮爾曼相關係數、線性迴歸進行分析。 研究結果：共收錄116位護理人員與232位病人，（1）整體溝通能力平均得分為85.2分（標準差=10.6，分數範圍=51-107）；（2）整體溝通能力與工作壓力呈負相關，與一般性自我效能、心理腫瘤照護自信心、同理心呈正相關；（3）病人感受到護理人員溝通能力、同理心、及滿意度之平均得分分別為56分（標準差=12.8，分數範圍=30-75）、23.7分（標準差=6.5，分數範圍=5-35）、71.8分（標準差=12.8，分數範圍=19-95）；（4）病人溝通能力感受與護理人員溝通能力無顯著相關，與工作壓力、崩潰、疲憊感呈負相關；（5）整體溝通能力重要因子為年齡、一般性自我效能、心理腫瘤照護自信心與同理心；溝通能力次面向－社交技能中，離職想法為正相關重要因子；心理腫瘤照護自信心為整體和溝通能力各次面向的重要因子。 結論與建議：腫瘤護理人員整體溝通能力重要因子為年齡、一般性自我效能、心理腫瘤照護自信心與同理心。離職想法，為溝通能力－社交技能正相關重要因子，說明腫瘤護理人員離職想法越高，越具備良好社交能力。而護理人員自身工作壓力、崩潰與疲憊感，才是直接影響病人溝通感受的因子。建議未來腫瘤護理人員教育訓練因同時著重身心支持及溝通技巧的培訓，其中又以心理腫瘤照護的教育訓練最為重要。

Background Oncology nurses serve as frontline responders to cancer patients, addressing emotional distress resulting from the disease, treatment side effects, and disease recurrence or progression. Communication skills are pivotal for oncology nurses to assess and provide support for the emotional challenges faced by cancer patients. However, in the post-pandemic era, research on the communication skills of oncology nurses and related factors remains significantly limited. Therefore, this study is committed to conducting an exploration of these issues. Purpose (1) Investigate the current status of communication skills among oncology nurses. (2) Explore the correlation between the communication skills of oncology nurses and their physical and psychological load, self-efficacy (general self-efficacy, psycho-oncology care confidence), and empathy. (3) Explore cancer patients' perceptions of the communication skills, empathy, and satisfaction levels of oncology nurses. (4) Investigate the correlation between cancer patients' perceptions of communication skills, empathy, satisfaction, and the physical and psychological load, self-efficacy, empathy, and communication skills of oncology nurses. (5) Identify the significant factors influencing the communication skills of oncology nurses. Method This study adopted a cross-sectional research design. Adopting a cross-sectional study design, the study purposively sampled participants from the oncology ward of a medical center in the northern region. Nursing data includes basic information, physical and psychosocial load, self-efficacy, empathy, and communication skills. Patient data includes basic information, communication skills, empathy, and satisfaction. Data were analyzed using descriptive and inferential statistics by Spearman's correlation coefficient and linear regression. Result A total of 116 oncology nurses and 232 cancer patients were included. (1) The overall average score for communication skills was 85.2(SD=10.6, range=51-107). (2) Overall communication skills exhibited a negative correlation with work-related stress and positive correlations with general self-efficacy, psycho-oncology care confidence, and empathy. (3) Patients' average scores for perceiving nurses' communication skills, empathy, and satisfaction were 56 (SD=12.8, range=30-75), 23.7 (SD=6.5, range=5-35), and 71.8 (SD=12.8, range=19-95), respectively. (4) Patients' perceptions of communication skills were not significantly correlated with nurses' communication skills. However, they exhibited a negative correlation with work-related stress, burnout, and fatigue. (5) Significant factors influencing overall communication skills included age, general self-efficacy, psycho-oncology care confidence, and empathy. Within the sub-dimension of social skills in communication, the intention to leave the job was identified as a significant positive correlating factor. Psycho-oncology care confidence emerged as a significant factor for both overall and all sub-dimensions of communication skills. Conclusion The key factors influencing the overall communication skills of oncology nurses are age, general self-efficacy, psycho-oncology care confidence, and empathy. Additionally, Intention to leave the job is the key positive correlation factor influences in social skill which is communication skill’s sub-dimensions. It means that the higher the intention of oncology nurses to leave the job, the more proficient they are in social skills. The nurses' own work stress, burnout, and fatigue are the direct factors influencing patients' perceptions of communication. It is recommended that future education and training for oncology nurses emphasize both physical and psychological support, communication skills with a particular emphasis on training in psycho-oncology care.