海洛因戒治者的關懷照護需求及護理人員的關懷照護行為
A Study of Caring Needs of Patients With Heroin Use Disorder, and Caring Behaviors of Nurses.
中文摘要
關懷照護係護理本質。本研究目的有三，一、探討海洛因戒治患者在住院期對關 懷照護行為的看法與需求；二、探討藥癮戒治病房護理人員對關懷照護行為的看 法；三、比較護理人員與病患對關懷照護行為的需求共識間之差異。
本研究屬橫斷式研究設計，採立意取樣，以台北市兩所精神專科醫院專屬之藥癮 病房為研究場所，31 位病患與 20 位護理人員為樣本，以修訂之「關懷照護行為 評估量表」為工具，經信校度檢定後收集資料，並依質性研究法訪談其中 22 位 病患與 15 位護理人員，以描述性統計、Kruskal-Wallis test 、Kolmogorov-Smirnov test、Mann-Whitney U test、Spearman correlation 與內容分析法進行資料分析。
研究主要發現：一、海洛因住院戒治者對關懷各層面重要性之看法以監測與追蹤 層面平均得分最高（M=6.21, SD=0.94），其次依序為舒適（M=6.08, SD=0.89）、
事先考慮（M=6.07, SD=0.89）、可近性（M=5.99, SD=0.80）、信賴的人際關係
（M=5.85, SD=0.87），最低的是解釋與促進（M=5.81, SD=1.03）。即病患重視透 過護理專業技能解決戒治問題，以達到舒適為目的，對護理人員的衛教及解釋需 求較低。二、戒治者需要的關懷行為之特性偏重以身體為導向，較不強調以認知 為導向。此外，在護病互動過程中護理人員溫柔態度、親切探視也是展現關懷之 表現。三、護理人員對關懷重要性看法平均得分最高是事前考慮層面（M=6.08, SD=0.73），依序為可近性（M=6.01, SD=0.61）、監測與追蹤（M=6.01, SD=0.63）、
舒適（M=5.96, SD=0.83）、解釋與促進（M=5.86, SD=0.83）、最低者是信賴的人 際關係（M=5.84, SD=0.61）。四、護理人員偏重認知為導向的行為，藉由解釋與 提供知識以表達關懷照護。五、護病間看法在各層面排序不同，部分層面與分項 行為間達統計學意義，護病雙方分別以理性與感性層面為主，顯示兩者對關懷照 護行為的解釋有落差。
本研究亦分析影響關懷照護行為看法之因素及可能原因，並針對增加兩者共識提 出建議，可作為臨床實務、護理教育及未來研究之參考。
英文摘要
The aims of the study are (1) to investigate the views of the patients with heroin use disorder on the nurses’ caring behaviors and their caring needs, (2) to examine the nurses’ perspectives of caring behaviors, and (3) to compare the differences of the patients’ and the nurses’ perspectives of caring behaviors.
A purposive sampling frame was used in the study. Thirty-one patients and twenty nurses were recruited from two hospitals, Taipei City Psychiatric Center and Armed Force Bei-Tou Hospital. The Caring Assessment Report Evaluation Q-sort
Questionnaire was used to collect quantitative data. Twenty-two patients and fifteen nurses participated in a semi-structured interview. The methods for data analysis included descriptive statistics, Kruskal-Wallis test, Kolmogorov-Smirnov test, Mann-Whitney U test, Spearman Correlation and content analysis.
The results revealed that the patients rated the most important caring behavior was
“Monitors and follows through” (M=6.21, SD=0.94). The following were
“Comforts”(M=6.08, SD=0.89),”Anticipates” (M=6.07, SD=0.89), “Accessible”
(M=5.99, SD=0.80), and ”Trusting relationship” (M=5.85, SD=0.87). The “Explains and facilitates” (M=5.81, SD=1.03) was rated as a least important one. The results suggested that the patients emphasized technical skills to solve substance use problem in order to feel more comfortable rather than the education and explanations from nurses. The nurses rated the most important caring behavior was “Anticipates”
(M=6.08, SD=0.73). The following were “Accessible” (M=6.01, SD=0.61),
“Monitors and follows through” (M=6.01, SD=0.63), “Comforts” (M=5.96, SD=0.83), and ”Explains and facilitates” (M=5.86, SD=0.83). The “Trusting relationship”
(M=5.84, SD=0.61) was rated as the least important one. The results suggested that the nurses emphasized providing explanations and education for the patients. The differences between the patients’ and the nurses’ views on caring behaviors were found.
The factors influence the nurses’ and the patients’ views on caring behaviors of nurses were discussed in this paper. The suggestions for improving nursing practice were also provided.
