社會認知理論為基礎的口腔護理教育介入對長期照顧機構照顧服務員之成效

The Effectiveness of an Oral Care Education Program Based on Social Cognitive Theory in Institutional Nursing Aide Training

背景：長期照顧機構住民口腔衛生會影響健康且增加照護需求和費用。發展適於不同背景照顧服務員（照服員）的口腔護理教育計畫至關重要。
目的：探討社會認知理論為基礎之口腔護理教育方案成效。
方法：採單組前、後測之類實驗設計，方便選樣選出苗栗四家長照機構照服員及住民各30位。執行社會認知理論為基礎口腔護理教育方案，主題為「守護健康，從齒開始」，授課時數570分鐘，介入後第2、4週分別進行成效評估。研究期間建立支持環境（口腔護理用具、文宣、標準作業手冊），並以廣義估計模式分析介入對照服員口腔護理認知及技能之成效。
結果：本研究共納入30位照服員，平均年齡36.8歲（SD = 8.5），90%為外籍及30位住民，平均年齡69.2歲（SD = 15.2），56.7%為男性。研究結果發現，照服員口腔護理認知得分與技能分數在介入後第二週及第四週比前測皆有顯著增加，住民口腔健康評估分數及牙菌斑指數在介入後四週有顯著改善。
結論：社會認知理論為基礎口腔護理教育方案能增加照服員口腔護理認知、技能，改善住民口腔健康。結果可提供長照機構未來在設計口腔護理教育計畫之參考。

Background: Poor oral hygiene among residents of long-term care facilities impacts the health and well-being of these residents and increases care demands and healthcare costs. As nurse aides play a key role in the daily care of these residents, developing an effective oral care education program tailored for nurse aides of diverse backgrounds is essential.
Purpose: This study was developed to examine the effects of an oral care education program based on Social Cognitive Theory in improving the oral-health-related knowledge, skills, and performance of nurse aides working in long-term care facilities.
Methods: A single-group, pre- and post-test, quasi-experimental design was employed. Convenience sampling was used to recruit and enroll 30 nursing aides and 30 residents from four long-term care facilities in Miaoli, Taiwan as participants. The educational intervention, entitled“Maintaining Health, Starting with the Teeth”, comprises 570 minutes of instruction. Two and four weeks post-intervention, assessments were conducted on the oral care knowledge and skills of the participants. Data on the oral health of the resident participants were collected at four weeks post-intervention. During the intervention, a supportive oral care environment was established in the long-term care facilities that included oral care tools, educational materials, and standardized operating procedures. The generalized estimating equation method was used to analyze the effect of the intervention on the nursing aide participants’oral care knowledge and skills. The generalized estimation model was used to analyze the effectiveness of the intervention and control staff on oral care cognition and skills.
Results: Thirty nursing aides (M = 36.8, SD = 8.5; 90% foreign) and 30 residents (M = 69.2, SD = 15.2; 56.7% male) were included in the study sample. The results showed the mean scores for oral care knowledge and skills of the nursing aide participants had significantly improved at both the second and fourth post-intervention weeks compared to baseline. For the resident participants, mean scores on the oral health assessment tool and Plaque Index were significantly improved over baseline at the fourth post-intervention week.
Conclusions/Implications for Practice: Based on the results, the Social Cognitive Theory-based oral care education program has the potential to substantially enhance the oral health knowledge and skills of nursing aides and to consequently improve oral care outcomes for residents in long-term care settings. These findings provide valuable guidance for the design of more-effective oral care education initiatives in long-term care facilities.