加護病房護理人員生命態度與死亡因應自我效能之相關性探討

The Relationship Between Life Attitude and Death Coping Self-Efficacy in Intensive Care Nurses

背景：護理人員是重症照護的核心人物，瞭解護理人員生命態度及死亡因應自我效能至關重要，是未來執行相關教育訓練之參考依據。目的：了解加護單位護理人員生命態度與死亡因應自我效能之概況與其之間的相關性，並探討生命態度對死亡因應自我效能之預測。方法：採橫斷式設計，研究對象為北部某醫學中心成人加護病房216位護理人員，研究工具為死亡因應自我效能量表及生命態度量表|採皮爾森積差相關、t-檢定、單因子變異數分析及多元迴歸等方式進行資料分析。結果：結果顯示：(1)相關得分為：死亡因應自我效能為112.0±14.3分，次量表以臨終關懷最高（51.1±6.3）|生命態度為128.9±13.8分，次量表以生命自主最高（24.0±3.2）。(2)有照顧末期撤除維生醫療經驗者死亡因應自我效能較佳（t = 1.94, p = .05）|研究所以上較大學（含專科）教育程度的生命態度較佳（t = -2.11, p = .04）。(3)年齡及加護年資與死亡因應自我效能之次量表哀傷因應呈顯著正相關（r = .315| r = .241）|生命態度次量表中理想、生命自主、愛與關懷與死亡因應自我效能達顯著正相關（r = .138−.482）。(4)年齡、理想、生命自主及愛與關懷為死亡因應自我效能之共同預測因子，解釋30.1%變異量（F = 12.78, p < .001）。結論：加護病房護理人員之生命態度影響其死亡因應自我效能|未來執行加護訓練及在職教育時建議強化生命態度和臨終關懷相關訓練，促進正向生命態度，進而增進死亡因應自我效能，提升重症臨床照護品質。

Background: Critical care nurses must often care for patients who are dying and their families. Thus, understanding the self-efficacy and life attitudes of nursing staff in the ICU in response to death is important to the development and provision of relevant education and training. Purpose: This study was designed to explore the self-efficacy of ICU nurses in response to death and related predictive factors. Methods: This was a cross-sectional research study. The subjects were 216 nurses in the adult ICU of a medical center in northern Taiwan. The research tools used included the death coping self-efficacy scale and the life attitude scale. Data were analyzed using Pearson’s correlation, t-test, one-way ANOVA, and multiple regression. Result: The results showed: 1. In terms of death coping self-efficacy, the mean score was 112.0±14.3, with the highest scoring subscale, hospice care, earning a mean score of 51.1±6.3. In terms of life attitude, the mean score was 128.9±13.8, with the highest scoring subscale, life autonomy, earning a mean score of 24.0±3.2. 2. Nurses with experiences of withdrawal of life support had better coping efficacy (t = 1.94, p = .05) and those with a graduate degree or above earned a better average life attitude score than those educated to the university / junior college level. 3. Age and ICU seniority were found to correlate positively with grief-related coping skills (r = .241−.315), with the life-attitude subscales of aspiring, life-autonomy, love, and caring showing positive correlations with death coping self-efficacy (r = .138−.482). 4. The predictors found in this study for death coping self-efficacy were age, aspiring, life-autonomy, love, and caring, with a total explained variance of 30.1% (F = 12.78, p < .001). Conclusion: The results of this study indicate that education level and having hospice care experience are both significant predictors of life attitude in ICU nurses, which is a factor that is known to affect self-efficacy in response to death. Life attitude and hospice care training programs for ICU nurses should be promoted to foster positive life attitudes and thereby enhance self-efficacy in response to death to improve the quality of intensive clinical care.