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系統識別號 U0026-2411201900042700
論文名稱(中文) 台灣居家護理師之長期照護護理能力及參與居家醫療照護整合計畫意願之相關性研究
論文名稱(英文) Correlation between long-term care nursing competences and willingness to serve in Home Medical Care Integration Program among home health care nurses in Taiwan
校院名稱 成功大學
系所名稱(中) 護理學系
系所名稱(英) Department of Nursing
學年度 108
學期 1
出版年 108
研究生(中文) 朱淳淳
研究生(英文) Chun-Chun Chu
學號 T26054105
學位類別 碩士
語文別 中文
論文頁數 120頁
口試委員 指導教授-陳靜敏
口試委員-陳桂敏
口試委員-盧豐華
中文關鍵字 居家護理  居家醫療照護整合計畫  參與意願  長期照護護理能力  計畫行為理論 
英文關鍵字 Home care nursing  Home medical care integration program  willingness  long term care nursing competence  Theory of planned behavior 
學科別分類
中文摘要 背景
全球正面臨人口快速老化之人口變遷,台灣於1993年成為高齡化社會,2018年正式進入高齡社會,預估2026年成為超高齡社會。隨著失能長期照護需求增加,老人住院比例及支出費用攀升,更突顯勞動人口的負擔日益沈重。失能、失智者伴隨行動不便、無法外出就醫,若採傳統醫療服務型態,已無法符合現代需求。為提升醫療照護可近性、降低住院天數、不必要住院及提供全人照護,2015年全民健康保險會公告訂定「居家醫療照護整合試辦計畫」,而居家護理人員為計畫中不可或缺的專業角色,對於其長期照護護理能力及參與政策意願之相關性,值得深入了解探討。
研究目的
1.瞭解居家護理人員人口學特質、長期照顧護理能力及參與衛生政策意願;2.探討人口學與長期照顧護理能力、參與意願之差異性;3.分析人口學資料與長期照顧護理能力及參與意願之相關性,並找出影響參與意願的預測因子。
研究方法
採橫斷式相關性研究,依台灣北、中、南、花東與離島四地區,以居家護理所為單位,採叢聚隨機抽樣共31家,共郵寄出130份問卷,回收有效問卷共123份。研究工具包括1.運用Schifter & Ajzen (1985)「計畫行為理論」為架構,自擬結構問卷收集人口學資料及參與意願 ,及2.引用謝(2014)長期照護之護理能力量表。以SPSS 22.0版軟體分析,描述性統計呈現平均值、百分比、標準差;推論性統計以獨立t檢定、Mann-Whitney U檢定、one-way ANOVA、Pearson’s correlation及Hierarchical Linear Model方法進行分析。
研究結果
研究對象99.2%為女性,平均41.25歲,87%已婚,服務機構屬性以醫院附設占38.2%、獨立型態占35.8%及衛生所附設占26%。居家護理年資平均7.5年,總護理年資平均18.1年,具護理師職稱者占70.7%,最高教育程度以大學為主(52.8%),僅有7.3%在職進修中。以具有臨床專業能力N2資格者(25.2%)居多,且多數已取得衛生福利部長期照護專業訓練資格(LevelⅠ,100%、LevelⅡ,81.3%、及LevelⅢ,55.3%)。有88.6%所服務機構提供教育訓練管道,有87%已參與居家醫療照護整合計畫服務中。自覺長期照護護理能力在「長期照護專業、倫理與法律」(M= 3.28± .56)部分表現優於「長期照護的提供與管理」(M=3.18± .54)及「長期照護角色專業發展」(M=3.12± .52)的得分。參與意願上,在「主觀規範」得分最高(M=3.01± .60),次之為「意向」(M=2.85± .65)、「態度」(M=2.85± .60)、「知覺行為控制」(M= 2.54± .70)。「接受完整在職訓練者」在「長期照護專業、倫理與法律」 (t=-2.36, p=.020)表現優於未接受完整訓練者;「獨立型態」居家護理人員自覺在「長期照護專業、倫理與法律」(F=3.15, p=.046)、「長期照護的提供與管理」(F=3.19, p=.045)、及整體長期照護護理能力(F=3.11, p=.048)表現上優於醫院附設及衛生所附設的居家護理人員。「未參與專業能力進階者」(t=3.07, p=.003)在「態度」構面得分高於參與進階者、「未完成長期照護在職訓練者」(t=2.04, p=.043)在「知覺行為控制」構面得分高於完成者、服務機構「有提供在職訓練管道者」(t=2.04, p=.035)在「意向」構面得分高於未提供者、「專科(含)以下之教育程度者」(t=.17, p=.040)在「整體參與意願」得分高於(含)大學以上之教育程度者、「未參與專業能力進階者」(t=2.49, p=.014)在「整體參與意願」得分高於參與者。「長期照護護理能力」與「參與意願」各構面間呈正相關,僅與參與意願之「知覺行為控制」構面(r=.15, p=.105)無顯著性相關。階層回歸分析中,「態度」構面之解釋總變異量18.8%最高,其次「知覺行為控制」16.1%及「意向」14.2%。找出六項影響參與意願之預測因子,於「長期照護角色專業發展」及「長期照護的提供與管理」對參與意願具正向影響力;而「服務於獨立型態居家護理所者」、「未參與專業能力進階者」、「已完成完整長期照護在職教育訓練者」及「長期照護專業、倫理與法律」具負向影響力。
結論與建議
因應高齡化醫療照護需求,2015年推動「居家醫療照護整合計畫」,居家護理人員為缺一不可之重要角色,因國內缺乏探討居家護理人員在參與意願之相關性研究,期藉本結果,提供未來護理科系學校與護理機構進行居家護理人員在職能力訓練參考,及政府可瞭解居家護理人員參與衛生政策的意願與困難,作為擬訂衛生政策參考。結果發現僅7.3%居家護理人員在職進修中、11.4%機構未提供教育訓練管道及46.3%未持續參與專業能力進階制度;在「長期照護護理能力量表」自評結果,發現在「熟知與長期照護相關的法律規章」、「有效整合相關研究和實證知識於長期照護護理實務」、「深入評估個案靈性需求」、及「評估臨終個案之心理及靈性需求」、「提昇長期照護護理在國際的能見度」的平均得分最低;在「未來居家護理若提供24小時電話應對或服務」得分最低,綜合以上於實務面應重視教育訓練管道透明化、在職進修與長期照護進階之鼓勵制度;教育與研究面建議護理機構、學校、學會或公會安排訓練課程時,可加強法律規章、心理與靈性評估照護、實證知識應用與研究發表;政策面建議先評估居家護理人員所擁有的資源與能力是否足以推動政策,並考量未來如何提供24小時居家護理服務。
英文摘要 SUMMARY
The world is facing demographic changes with a rapidly aging population.The National Health Insurance announced the “Home Medical care Integration Pilot Program” in 2015, and the home care nurse is an indispensable specialized role of this program. Home care nurses’ long-term care nursing competence and willingness to participate in policy is worth further investigation. A cross-sectional correlation study was conducted, total 123 subjects.The long-term care competence of the subjects was assessed in three domains with the scores of "long-term care profession, ethical and legal" (M=3.28±.56), "long-term care provision and management" (M=3.18±.54) and "long-term care role professional development" (M=3.12±.52). The willingness to serve, the subjects’ “subjective norm” scored the highest (M=3.01±.60), followed by "intention" (M=2.85±.65), "attitude" (M=2.85±.60), and "perceived behavior control" (M=2.54±.70). There were positive correlations between the three dimensions of long-term care nursing competence and the four dimensions of participation willingness with only no significant finding in "perceived behavior control" dimension (r=.15, p=.105). Results of the hierarchical regression analysis shown significant predicting factors of attitude, perceived behavior control and intention which explained 18.8%, 16.1% and 14.2% of the total variances. It is expected that the results of this study will provide nursing schools and nursing institutions reference of the home care nurse’s competence and on-the-job training in the future. As well as the government’s health policy process to understand the willingness and difficulties of home care nurses to participate, and as a reference for future revision of this policy.
INTRODUCTION
Taiwan became an aging society in 1993, officially entered an aging society in 2018, and is estimated that it will become a super-aged society in 2026.With the increasing demand for long-term care, the proportion of hospitalizations and expenditures for the elderly has risen, highlighting the increasing burden on the working population.Due to the difficulties for disabled and demented people to move around for seeking medical treatment, the new health care service model to improve accessibility, reduce the hospitalization days and needless hospitalizations and provide holistic care is needed. The purpose of this study was 1.To examine the nurses’demographic characteristics, long-term care nursing competence and willingness to serve in health policy of home care nurse in Taiwan, 2. To explore the relationships among nurses’ demographics and their long-term care nursing competence and willingness to serve,3.To analyze the correlation between demographic data and long-term care nursing competence and willingness to serve, and to identify the predictors of willingness to serve.
METHODS
The cross-sectional correlation study was conducted and the cluster random sampling method was adopted in four areas of North, Central, South, East and Offshore islands of Taiwan. A total of 31 home care nursing units were sampled and 130 questionnaires were mailed with 123 valid ones retrieved . The research instruments included as follows. 1. The willingness to service and demographic data were developed based on "Theory of Planned Behavior" model (Schifter & Ajzen, 1985). 2. The long term care nursing competence scale developed by Hsieh (2014). SPSS 22.0 software was used for data analysis, mean, standard deviation and percentage were used for the descriptive statistics; inferential statistics were analyzed using independent t test, Mann-Whitney U test, one-way ANOVA, Pearson's correlation and Hierarchical Linear Model.
RESULTS AND DISCUSSION
Among 123 subjects, 99.2% were women, 87% married, with an average of 41.25 years old distributed from 38.2% of the hospital based, 35.8% of the free stand and 26% of the primary health station based home nursing agencies. Their average working experience was 18.1 years and specialized in home nursing was 7.5 years. The majority of the subjects were registered nurses (70.7%) with highest education level of university graduates (52.8%), and only 7.3% were still pursing further education. Most of them obtained N2 in clinical ladder (25.2%), and most had completed the long-term professional training certified by the Ministry of Health and Welfare (Level I, 100%, Level II, 81.3%, and Level III, 55.3%). There were 88.6% of the agencies provided education and training channel, and 87% had joined the home medical care integrated program. In terms of willingness to serve, the subjects’ “subjective norm” scored the highest (M=3.01±.60), followed by "intention" (M=2.85±.65), "attitude" (M=2.85±.60), and "perceived behavior control" (M=2.54±.70). There were statistically significant relationships found between demographic variables and long-term care nursing competence. Those completed long -term care training had better "long-term care profession, ethical and legal" in the long-term care nursing competence than their counterparts (t= -2.36, p= .020). "The nurse serve in the free stand facility" have statistically significant –higher "long-term care profession, ethical and legal" (F= 3.15, p=.046), "provision and management of long-term care" (F= 3.19, p=.045), and the overall long-term care and nursing competence (F=3.11, p=.048) than those in hospital or primary health care center based agencies. Significant relationship between demographic variables and willingness were found in level of clinical ladder and "attitude" (t = 3.07, p = .003). Those who hadn’t completed long-term care training showed a significant higher score in the "perceived behavior control" (t=2.04, p=.043); agencies provided on-job training had showeda better "intention" to serve than others (t=2.04, p=.035). There were significant differences in educational level (t=.17, p=.040) and advance training (t=2.49, p=.014) with "overall willingness". There were six factors predicting willingness in common included long-term care role professional development and long-term care provision and management in the long-term care nursing competence, type of home nursing agencies, participating at the advanced training and score of long-term care nursing competence in long-term care profession, ethical and legal.
CONCLUSION
In response to the demand for aging care, Taiwan has promoted the “home medical care integration plan” since 2015 for whom home care nurse are indispensable for this project. It is found that only 7.3% of the home care nurses were pursuing further education and 11.4% of the agencies did not provide education training channels and 46.3% did not continuously participate in the professional competency advancement system. In term of perceived long-term care nursing competence, we found that "familiar with laws and regulations related to long-term care", "effective integration of relevant research and empirical knowledge in long-term care nursing practice", " the spiritual demand of in-depth assessment ", and "psychological and spiritual needs of dying patient", "promote long-term care nursing in international visibility" scored the lowest. It was found that "if the home care is required to provide 24-hour telephone response or night shift service in the future" had the lowest average score in willingness. Based on the above results, it is recommended that in the future, we should pay attention to the transparency of the education and training channels for home care nurse, and to establish an in-service training and motivation for long-term care advancement system. In terms of recommendation for education and research, it is suggested to strengthen laws and regulations, psychological and spiritual assessment and care for the home patients, apply empirical knowledge to home-based care, and integrate the results of research and publication for further education. Finally, assessment for nurses’ resources and competences before policy implementation should be recommended. If 24-hour home care service is required in the future, the relevant staffing arrangement should also be considered for the needs of home care nurses.

論文目次 中文摘要 ……………………………………………………………Ⅰ
英文摘要………………………………………………………………Ⅲ
致謝……………………………………………………………………Ⅵ
第一章 緒論 ………………………………………………………………1
第一節 研究背景及重要性 …………………………………………………1
第二節 研究動機 ……………………………………………………………3
第三節 研究目的 ……………………………………………………………5
第四節 名詞解釋 ……………………………………………………………6
第二章 文獻查證 …………………………………………………………7
第一節 從居家護理到居家醫療照護整合的發展 …………………………7
第二節 長期照護護理能力與測量工具 …………………………………12
第三節 影響長期照顧護理能力表現的相關因素 ………………………16
第四節 居家醫療照護整合計畫參與意願的理論依據與測量工具………19
第五節 影響「參與意願」之相關因素 …………………………………22
第六節 研究架構 ………………………………………………………… 27
第七節 研究假設 ………………………………………………………… 28
第三章 研究方法 ………………………………………………………29
第一節 研究設計…………………………………………………………… 29
第二節 研究對象與場域…………………………………………………… 29
第三節 研究工具 ……………………………………………………………30
第四節 研究工具的信效度 …………………………………………………32
第五節 倫理考量…………………………………………………………… 35
第六節 資料收集步驟 ………………………………………………………36
第七節 資料整理與分析 ……………………………………………………38
第四章 研究結果………………………………………………………40
第一節 人口學調查結果………………………………………………………40
第二節 長期照護護理能力現況………………………………………………44
第三節 參與意願現況…………………………………………………………54
第四節 人口學與長期照護護理能力之關係…………………………………58
第五節 人口學與參與意願之關係……………………………………………62
第六節 長期照護護理能力與參與意願之關係………………………………66
第七節 參與意願之多元迴歸分析……………………………………………68
第五章 討論……………………………………………………………72
第一節 居家護理人員之人口特質討論 ………………………………………72
第二節 影響長期照護護理能力之因素討論 …………………………………74
第三節 影響參與意願之因素討論 ……………………………………………76
第四節 長期照護護理能力與參與意願之關係討論 …………………………79
第五節 參與意願之預測因子討論 ……………………………………………80
第六章 結論與建議……………………………………………………82
第一節 結論 …………………………………………………………………82
第二節 建議 …………………………………………………………………83
第三節 研究限制 ……………………………………………………………85
參考文獻 …………………………………………………………………87

附件
附件一 使用長期照護護理能力量表之授權同意書 …………………………96
附件二 專家效度名單 …………………………………………………………97
附件三 專家內容效度分數與專家意見 ………………………………………98
附件四 研究說明書與問卷 ………………………………………………… 113
附件五 奇美醫療財團法人奇美醫院人體試驗委員會研究核准函 ………123

表目錄

表一 影響長期照護護理能力表現的相關因素…………………………………18
表二 影響參與意願的相關因素…………………………………………………26
表三 樣本分配比例………………………………………………………………30
表四 專家內容效度(CVI)與修改前、後題數 …………………………………33
表五 信度檢定……………………………………………………………………34
表六 居家護理人員之人口學變項………………………………………………42
表七 長期照護護理能力之長期照護專業、倫理與法律………………………46
表八 長期照護護理能力之長期照護的提供與管理……………………………49
表九 長期照護角色專業發展……………………………………………………53
表十 居家醫療照護整合計畫之參與意願………………………………………56
表十一 人口學變項與長期照護護理能力之差異性分析………………………59
表十二 人口學變項與長期照護護理能力之皮爾森相關性分析………………61
表十三 人口學變項與居家醫療照護整合計畫參與意願之差異性分析………63
表十四 人口學變項與居家醫療照護整合計畫參與意願之相關性分析………65
表十五 長期照護護理能力與參與意願各構面之相關性分析…………………67
表十六 各預測變項對於參與意願之階層回歸分析……………………………71

圖目錄

圖一、計畫行為理論架構圖…………………………………………………………20
圖二、研究架構圖……………………………………………………………………27
圖三、研究流程圖……………………………………………………………………37
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