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系統識別號 U0026-2706201921510500
論文名稱(中文) 發展「遺體護理融合急性哀傷撫慰」可信賴專業活動
論文名稱(英文) Development of “Integration of Postmortem Care and Acute Bereavement Care” Entrustable Professional Activities
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 107
學期 2
出版年 108
研究生(中文) 劉梨榛
研究生(英文) Li-Chen Liu
學號 T26061021
學位類別 碩士
語文別 中文
論文頁數 111頁
口試委員 指導教授-賴維淑
口試委員-黃美智
召集委員-蕭政廷
中文關鍵字 遺體護理  急性哀傷撫慰  可信賴專業活動  修正型德菲法  信賴授權 
英文關鍵字 postmortem care  acute bereavement care  entrustable professional activity  modified Delphi method  entrustment decision 
學科別分類
中文摘要 背景及重要性:「遺體護理融合急性哀傷撫慰」能撫慰喪親家屬於病人死亡當下的急性哀傷,然而,遺體護理融合急性哀傷撫慰為當今醫護教育所欠缺的一環。因此,建立以能力為導向界定護理教育養成過程之各階段里程碑,並發展可信賴專業活動(Entrustable Professional Activities, EPAs),有助於提升護生於執行遺體護理時,提供適切急性哀傷撫慰之照護能力。
研究目的:發展以能力為導向「遺體護理融合急性哀傷撫慰」可信賴專業活動之核心能力、內涵、里程碑及評估工具,並確認其適用性。
研究方法:本研究先以廣泛性文獻查證為基礎,採修正型德菲法,邀請12位跨領域專家,進行修正型德菲法共識程序,建立「遺體護理融合急性哀傷撫慰」EPA之核心能力、任務描述、內涵、里程碑、評估工具;為確認里程碑計畫之適切性,採方便取樣,以南部某大學護理系一到四年級學生共84位為對象,回收率62.7%,以專家共識之里程碑計畫為基礎,擬定「遺體護理融合急性哀傷撫慰可信賴專業活動自評問卷」,以眾數、平均值以及四分位差等描述性統計分析,確認里程碑計畫的適用性。
研究結果:第一回合專家審查確立「遺體護理融合急性哀傷撫慰」四大面向為評估文化宗教儀式、臨終準備、遺體護理、急性哀傷撫慰,及其各次面向、內涵敘述。採Likert 1-5點量表,「同意程度」平均分數4.79,「內容重要性」平均分數4.82,四分位差0-0.5之間,眾數5分。第二回合專家審查旨在建立「遺體護理融合急性哀傷撫慰」可信賴專業活動(EPAs)的四大部分:(一)核心課程(二)任務描述(三)里程碑計畫;(四)評估工具;「同意程度」總平均分數為4.85,四分位差0-0.5之間,眾數5分;兩回合圈選4、5分人數比例達到90%,回收率為100%,專家間達成高度共識。繼之,以「遺體護理融合急性哀傷撫慰可信賴專業活動自評問卷」確認里程碑計畫的適切性,專家共識所建立的里程碑Level與學生自評勝任能力對照,92%具高度一致性,意即Level低者,相對學生自評勝任能力高。
結論:本研究發展「遺體護理融合急性哀傷撫慰」EPA之核心課程、內涵敘述、任務描述、里程碑計畫及評估工具,可作為護理教育課程設計與情境化任務信賴授權之參考,以提升「遺體護理融合急性哀傷撫慰」照護品質。
英文摘要 The integration of postmortem care and acute bereavement care is lack in medical and nursing curriculum. Development of the milestones in nursing education with competency based and Entrustable Professional Activities contribute to promote the competencies of the nursing students in integration of postmortem care and acute bereavement care. We first conducted extensive literature review, then there were twelve experts entered one rounds of modified Delphi method and one round of experts consensus to develop the EPA competencies, required knowledge, skills, and attitudes, milestones and an assessment tool of “Integration of Postmortem Care and Acute Bereavement Care”. Then, 84 students from department of nursing in southern Taiwan were recruited by convenience sampling and done the “Student Self-Assessment Questionnaire”, which was modified by the milestones after expert consensus. In the modified Delphi method, there were 90% experts select score 4 and 5 and the overall response rate of questionnaire was 100%, which means all experts reached consensus. The milestone of expert's consensus was compared with the Student Self-Assessment Questionnaire, 92% items reached consensus. The EPA can be used as a reference for nursing education and entrustment decision to enhance the quality of “Integration of Postmortem Care and Acute Bereavement Care”.
論文目次 中文摘要………………………...…………………………....……………………….….....I
英文摘要………………………...…………………………………………………….......III
致謝……………………………...………………………………………………….…......VI
目錄……………………………...…………………………………………………….....VII
表目錄…………………………...……………………………………………………........X
圖目錄…………………………...……………………………………………………........X

第一章 緒論………………….…………………………………………………………...1
第一節 研究動機及重要性…………..…………………………………………………..1
第二節 相關概念定義……………………...…………...………………………………..4
一、遺體護理…………………………..…...……………………………..………...….4
二、急性哀傷撫慰………………………..……...……………………………………..4
三、可信賴專業活動………..……………….....…………………………………...….4
四、核心能力…………..………………..………………....………………………...…4
五、里程碑.…………………………..……………..……...…………………………...4
六、內涵………..…………………….…....……..……………………………………..5
第三節 研究目的…………………………….……………………………………….…..5
第四節 研究問題………………….………………………………………………….…..5
第二章 文獻查證……………………………………….…………………….…………....6
第一節 可信賴專業活動…………………………………………..…………………..…6
第二節 死後身體變化與遺體護理………………………………………………….…...9
第三節 從家屬觀點看遺體護理………………………………………….…………….12
第四節 哀傷與急性哀傷撫慰………………………….…..………………..……….…13
第五節 探討新手執行遺體護理的困難………………………………...……….……..14
第三章 研究方法………..…………….………………………….…………………..…..16
第一節 研究方法的選擇.……………………………...……………...………….……..16
第二節 修正型德菲法.………………………………….………………...…………….16
第三節 研究參與者的選擇………………………………….………………..………...19
第四節 研究工具…………………………………….……………………….….….…..20
第五節 資料收集流程………………………..………………………………….….…..23
第六節 資料分析…………………………….…………………………………...……..25
第七節 倫理考量………………………………….…………………….……….….…..26
第四章 研究結果………..…………….………………………….…………………..…..27
第一節 修正型德菲法專家小組之基本資料………...….…………...………….……..28
第二節 第一回合專家審查共識結果.………………….………………...…………….30
第三節 專家審查共識結果………………………………….………………..………...35
第四節 「遺體護理融合急性哀傷撫慰」可信賴專業活動之核心能力.…….….….…..38
第五節 「遺體護理融合急性哀傷撫慰」可信賴專業活動之內涵敘述.…….….….…..40
第六節 「遺體護理融合急性哀傷撫慰」可信賴專業活動之里程碑計畫..………….42
第七節 「遺體護理融合急性哀傷撫慰」可信賴專業活動之評估工具………..……...46
第八節 「遺體護理融合急性哀傷撫慰」可信賴專業活動之核心課程…….….….…..47
第九節 「遺體護理融合急性哀傷撫慰」可信賴專業活動適切性………….….….…..48
第五章 討論……………..…………….………………………….…………………..…..54
第一節 可信賴專業活動嚴謹度………...……………….…………...………….……..54
第二節 「遺體護理融合急性哀傷撫慰」四大面向………………....…….………….55
第三節「遺體護理融合急性哀傷撫慰」與學生能力展現…………....…….………….56
第四節「遺體護理融合急性哀傷撫慰」與里程碑適切性…....…………….………….58
第五節「遺體護理融合急性哀傷撫慰」與護理教育培訓..………………….………….59
第六節「遺體護理融合急性哀傷撫慰」與EPA建構…....………………….…………60
第七節「遺體護理融合急性哀傷撫慰」與EPA品質…....………………….…………61
第六章 結論與建議……..…………….………………………….…………………..…..62
第一節 臨床應用………………………...……………….…………...………….……..62
第二節 護理教育之建議………………...……………….…………...………….……..62
第三節 研究限制………………………....…………….…….…………...…………….63
第四節 未來研究建議……………………………………….………………..………...64
第五節 結論………………………………………………….………………..………...64

參考文獻………..…………….……………………………….………………….…….....66
附件一 修正型德菲法專家審查共識小組成員..……………………………..………..74
附件二 「遺體護理融合急性哀傷撫慰」可信賴專業活動-專家審查…...…….….....75
附件三 「遺體護理融合急性哀傷撫慰」可信賴專業活動-第二回合專家審查……...82
附件四 第一回合專家審查建議……………………………………….....………….....91
附件五 專家審查建議………………………………………………….....……….…....95
附件六 「遺體護理融合急性哀傷撫慰」可信賴專業活動自評問卷…………..……103
附件七 原專家共識「遺體護理融合急性哀傷撫慰」可信賴專業活動里程碑…..…105
附件八 南部某大學課程地圖及階層目標...……………………………………...……108
附件八 EPA 品質評量工具Equal………………………………………………...……109


表目錄
表一 修正型德菲法專家小組人口學資料…………………………....…………………28
表二 第一回合專家審查意見同意程度共識結果…………………....…………………30
表三 第一回合專家審查意見內容重要性共識結果……………………………………32
表四 專家審查建議同意程度共識結果…………………...................…………….……36
表五 「遺體護理融合急性哀傷撫慰」可信賴專業活動任務描述……………….……38
表六 「遺體護理融合急性哀傷撫慰」可信賴專業活動之內涵敘述…………….……40
表七 「遺體護理融合急性哀傷撫慰」可信賴專業活動里程碑計畫…………….……43
表八 「遺體護理融合急性哀傷撫慰」可信賴專業活動評估工具….…………….……46
表九 「遺體護理融合急性哀傷撫慰」可信賴專業活動之核心課程…….….……….…47
表十 受試者基本資料…….….…….….…………….….…………….….…...…….……48
表十一 「遺體護理融合急性哀傷撫慰」可信賴專業活動自評問卷結果……….……50
表十二 大學生自評勝任能力與「遺體護理融合急性哀傷撫慰」四大面向……...……52
表十三 大學生自評勝任能力與實習經驗之相關……............................................……53
表十四 大學生自評勝任能力與階層目標之相關……............................................……53

圖目錄
圖一 修正型德菲法共識決策程序流程.....………………....……………………….…..18
圖二 資料收集流程.....………………....……………………….………………………..24
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