護理人員對末期臨終照護自我效能影響因素之研究

The Correlates of Nurses' Self-Efficacy for End-of-Life Care

背景：自我效能在維持人類健康行為扮演一項重要角色；護理人員若能深入瞭解對末期臨終照護自我效能影響因素，將更能提供末期病人需要的臨終照護。目的：探討末期臨終照護自我效能之重要影響變項及其相關性。方法：採描述性相關研究設計，方便取樣南部某教學醫院214位護理人員為研究對象，橫斷性收集臨終照護知識、態度、自我效能問卷資料。結果：護理人員末期臨終照護之（1）知識平均得分13.99±1.63（70％），顯示知識有待加強、（2）態度平均得分46.74±4.39（78％），顯示態度微偏正向、（3）自我效能平均得分48.46±10.37（61％），顯示自信不足。末期臨終照護知識、態度及自我效能之間有顯著正相關；複迴歸分析顯示工作單位、照護末期病人的經驗、末期臨終照護知識及態度，解釋臨終照護自我效能之變異量達42.54％。結論／實務應用：護理人員的正確知識和正向態度，有助於幫助病人與家屬醫療決策時的自信程度。醫院行政者應提供護理人員院內外在職教育及安排跨科訓練，以提升其末期臨終照護經驗及自我效能。

Background: Self-efficacy plays an important role in maintaining health-related behaviors in humans. Nursing staffs should understand the factors that influence self-efficacy in end-of-life (EOL) care in order to ensure their ability to provide appropriate palliative care to EOL-stage patients. Purpose: To explore the important variables affecting the self-efficacy of nursing staffs in providing EOL care and the correlations between self-efficacy and these variables. Methods: This study adopted a descriptive, correlational design. The participants were convenience sampled from registered nurses employed at a teaching hospital in southern Taiwan. The data collection was cross-sectional and 214 registered nurses completed a structured questionnaire on knowledge, attitudes, and self-efficacy with regard to providing EOL care. Results: The results indicated that that participants had (1) an average knowledge level of EOL care (13.99 ± 1.63), demonstrating that nursing staff need to improve their knowledge of EOL care, (2) an average level of attitude (46.74 ± 4.39), demonstrating a slightly positive attitude toward EOL care, and (3) an average level of self-efficacy (48.46 ± 10.37), demonstrating inadequate confidence in providing EOL care. A Pearson product-moment correlation analysis was conducted, showing significant and positive correlations between self-efficacy and the variables of EOLcare knowledge and attitude. Multiple regression analyses revealed that work unit, experience providing EOL care, knowledge regarding EOL care, and attitude toward providing EOL care together explained 42.54% of the variance in EOL care self-efficacy. Conclusions/Implications for Practice: Accurate knowledge about and positive attitude toward providing EOL care are important in fostering confidence in nurses to help patients and their family make appropriate medical decisions and to provide appropriate EOL care. Hospital administrations should provide onsite or offsite continuous education and, when appropriate, arrange interdisciplinary and cross-training programs to enhance the EOL-carerelated experience and self-efficacy of nurses.