臺灣博碩士論文加值系統

背景 護理人員在醫療團隊中常常是病患發生突發狀況，需要急救的目擊者或者為最先到達的專業人員。因此護理人員是否有能力處理緊急狀況，往往關係著病患的預後。高級心臟救命術課程目的在於教育醫療專業人員，使之能夠獲得急救病患時所需的技術與知識。
目的 本研究目的為探討護理人員接受高級心臟救命術課程後自評執行急救能力之狀況，以及探討不同基本屬性之護理人員對其自評急救能力之影響，並分析護理人員自評急救能力之預測因素。
方法 本研究採橫斷性研究設計(cross-sectional studies)問卷調查法，以醫學中心護理人員自我評估急救能力量表，針對臺北市某醫學中心參與過高級心臟救命術課程一年內之護理人員，採全面普查進行問卷調查。自2011年9月20日至2012年1月10日止，經過醫院IRB審核通過，並取得受試者同意進行資料收集，共發放223份問卷，回收187份，回收率為83.9%，總計有效問卷數為176份，有效問卷回收率為94.1%。研究工具採自擬「護理人員自我評估急救能力量表」，經過專家效度及內在一致性信度檢定，Cronbach’s α值為0.957。
結果 本研究結果發現，護理人員自我評估執行急救能力，共計35題，整體平均得分為4.13分(Likert 5分量表)。平均得分最高的項目為「正確執行抽痰技術」(M = 4.66 ± 0.52)；最低的項目為「運用AHA Guidelines的重大變革於急救情境中」(M = 3.47 ± 0.92)。另利用探索式因素分析建構出六個因素，分別為：呼吸道及循環之維持、團隊合作和異常處理、病患與家屬之溝通協調、異常心律之判讀及處置、急救評估及初步處置與護理急救角色功能之展現，六個因素合計共解釋61.72%的變異量。在個人基本屬性與整體自評執行急救能力之差異分析中，不同年齡、護理晉階層級、年資及參與急救課程意願等變項有顯著的差異存在。參與急救課程意願可解釋整體護理人員自我評估執行急救能力22.8%變異量，調整後變異量為16.8%。
結論 期望藉由此研究分析護理人員自我評估接受高級心臟救命術課程後執行急救能力，除可提供醫院管理者進一步思考，如何讓醫學中心之護理人員具備應有之急救能力外，建議可加強護理人員自評急救能力較弱的部份，如：運用AHA Guidelines的重大變革於急救情境中、異常心律的處理與判讀方面、協助醫師找出病患急救的原因(5H/5T)與病患及家屬進行溝通與協調之能力。本研究結果發現之六大急救能力，亦可當作評值高級心臟救命術訓練課程之教育訓練成效指標，作為後續急救教育訓練之參考。

Background: As nurses often discover patients who have had a critical situation at first, they should be trained and be able to perform resuscitation skills adequately. The need for effective advanced cardiac life support (ACLS) training is clear, it has never been more important to ensure the competence of healthcare professionals.
Goal: This article is a report of a study that analyzes of self-evaluated the performance of ACLS skills, examines the association between demographic data and self-evaluated the performance of ACLS skills, and explores the predictors of self-evaluated resuscitation competency amony clinical nurses.
Method: This descriptive and correlational study used a cross-sectional survey of 223 clinical nurses from a medical center in northern Taiwan from Sep. 20, 2011 to Jan. 10, 2012. We use “nurse’s self-assessment and performance of ACLS skills in medical center” scale as an instrument to measure the subjects who had attended ACLS training for one year. Out of 223 questionnaires sent out, 176 were completed in full giving an effective responsive rate was 94.1%.
Results: “Nurse’s self-assessment and performance of ACLS skills in medical center” scale, in a total of 35 questions, the overall average score was 4.13 (5-point Likert scale). The item that get the highest average score is “correct execution of suction technology” (M = 4.66 ± 0.52), while the lowest is “Using AHA Guidelines major changes in the resuscitation situations” (M = 3.47 ± 0.92). By items analysis and explorations as well as exploratary factors analysis, extracted into six factors, named for: the ability of maintenance of the respiratory and circulatory, teamwork and exception handling, communication and coordination of the patients and their families, interpretation and disposal of abnormal heart rhythm, resuscitation assessment and initial management, show of the nurse’s role in resuscitation situations. Six factors total explained 61.72% of the variance. Subjects’ demographic and facilities characteristics influenced on subjects’ different dimensions of the self-assessment competence. Significant related factors of subjects’ competence were as follows: age, professional level, practicing years, will of attending in resuscitation training programs. Perception of will that attend in resuscitation training programs were predictors of perceived nursing resuscitation competence, and they accounted 22.8% of its variance, adjusted variance was 16.8%.
Conclusion: We expect hospital management can think actively on how to improve nurse’s ability in resuscitation skills and strengthen the weaker part, such as “To use AHA Guidelines major changes in the resuscitation situations”, “interpretation and disposal of abnormal heart rhythm”, “Assist physicians to find out the resuscitation reasons (5H5T)” and “communication and coordination of the patients and their families”. The conclusion not only evaluates the outcomes of ACLS training but also provides the reference for nurses proceeding education.

目錄
第一章 緒論---------------------------------------------------------------1
第一節 研究背景及動機------------------------------------------------------1
第二節 研究目的-----------------------------------------------------------4
第三節 研究問題-----------------------------------------------------------4
第四節 名詞界定-----------------------------------------------------------4
第二章 文獻查證-----------------------------------------------------------6
第一節 高級心臟救命術訓練課程-----------------------------------------------6
第二節 技能評估的理論與模式-------------------------------------------------7
第三節 急救能力-----------------------------------------------------------9
第四節 國內外相關研究------------------------------------------------------10
第三章 研究方法-----------------------------------------------------------19
第一節 研究設計-----------------------------------------------------------19
第二節 研究架構-----------------------------------------------------------19
第三節 研究對象-----------------------------------------------------------21
第四節 研究工具-----------------------------------------------------------22
第五節 研究步驟-----------------------------------------------------------25
第六節 研究倫理-----------------------------------------------------------27
第七節 資料分析-----------------------------------------------------------27
第四章 研究結果-----------------------------------------------------------29
第一節 研究對象基本屬性----------------------------------------------------29
第二節 護理人員自評執行急救能力之分佈情形------------------------------------33
第三節 護理人員自評執行急救能力之因素分析------------------------------------39
第四節 護理人員自評執行急救能力之差異分析------------------------------------45
第五節 護理人員自評執行急救能力之預測因子------------------------------------52
第五章 討論--------------------------------------------------------------67
第一節 研究對象基本屬性之分析----------------------------------------------67
第二節 護理人員自評執行急救能力之分佈情形------------------------------------68
第三節 探討護理人員自評執行急救能力之因素分析結果-----------------------------70
第四節 基本屬性對護理人員自評執行急救能力之影響-------------------------------72
第五節 影響護理人員自評執行急救能力之預測因子---------------------------------76
第六章 結論與建議----------------------------------------------------------77
第一節 結論---------------------------------------------------------------77
第二節 研究限制與建議------------------------------------------------------78
參考文獻------------------------------------------------------------------82
中文部分------------------------------------------------------------------82
英文部分------------------------------------------------------------------87
附件---------------------------------------------------------------------94
附件一 美國心臟學會ACLS課程參考規範和要素-----------------------------------94
附件二 台灣北部醫學中心參照聯委會課程規範舉辦ACLS課程計畫表-------------------96
附件三 Wayne急救能力自我評估量表資料---------------------------------------98
附件四 護理人員自我評估執行急救能力問卷-------------------------------------105
附件五 量表項目資料來源---------------------------------------------------108
附件六 專家效度委員一覽表-------------------------------------------------109
附件七 專家效度檢定------------------------------------------------------110
附件八 信度檢定---------------------------------------------------------119
附件九 參與研究同意書----------------------------------------------------123

圖表索引
圖1 研究概念架構圖(先驅研究)-------------------------------------------20
圖2 研究架構圖(正式研究)----------------------------------------------21
圖3 問卷發展過程圖----------------------------------------------------23
圖4 研究步驟流程圖----------------------------------------------------26
表2-4-1 急救能力相關研究之彙整---------------------------------------------14
表3-7-1 資料分析統計方法--------------------------------------------------28
表4-1-1 研究對象基本屬性之分佈情形-----------------------------------------30
表4-2-1 護理人員自評執行急救能力之題項情形----------------------------------35
表4-2-2 護理人員自評執行急救能力之得分情形----------------------------------37
表4-3-1 護理人員自評執行急救能力之因素分析矩陣與信度分析----------------------41
表4-3-2 護理人員自評執行急救能力之因素負荷量---------------------------------43
表4-3-3 護理人員自評執行急救能力之因素相關性分析-----------------------------44
表4-3-4 護理人員自評執行急救能力之因素平均數與標準差--------------------------44
表4-4-1 年齡對護理人員自評執行急救能力之差異---------------------------------47
表4-4-2 教育程度及護理進階層級對護理人員自評執行急救能力之差異-----------------48
表4-4-3 工作年資及工作單位性質對護理人員自評執行急救能力之差異-----------------49
表4-4-4 急救相關課程及急救認證對護理人員自評執行急救能力之差異-----------------50
表4-4-5 參與急救課程意願對護理人員自評執行急救能力之差異----------------------51
表4-5-1 背景變項與護理人員自評執行急救能力之多元迴歸分析----------------------54
表4-5-2 背景變項與護理人員自評執行急救能力之簡單及多元線性迴歸分析-------------56
表4-5-3 背景變項與護理人員自評執行呼吸道及循環維持能力之簡單及多元線性迴歸分析---57
表4-5-4 背景變項與護理人員自評執行團隊合作和異常處理能力之簡單及多元線性迴歸分析-62
表4-5-5 背景變項與護理人員自評執行病人與家屬溝通協調能力之簡單及多元線性迴歸分析-63
表4-5-6 背景變項與護理人員自評執行異常心律判讀及處置能力之簡單及多元線性迴歸分析-64
表4-5-7 背景變項與護理人員自評執行急救評估及初步處置能力之簡單及多元線性迴歸分析-65
表4-5-8 背景變項與護理人員自評執行護理急救角色功能展現能力之簡單及多元線性迴歸分析66

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