臺灣博碩士論文加值系統

護理人員在病患的健康照護角色中，強調整體性護理的重要性，也承諾性健康照護是護理的一環，國內外文獻指出護理人員提供病患的性健康照護不足夠，品質有待提升，因而確認干擾或阻礙護理人員提供性健康照護過程的因素益顯重要。國內外相關文獻的探討著重護理人員的性知識、性態度與護理行為間關係的探討，對於泌尿科也尚無文獻報告。本研究因此探討泌尿科護理人員提供病患性衛教面臨問題的發生頻率、困擾程度與需要協助的程度，以提供本土初探性資料作為護理專業發展性健康照護與教育課程安排之參考。
研究採敘述性橫斷式研究調查法，以立意取樣的方式選取北部準醫學或醫學中心工作屆滿三個月的泌尿科女性護理人員共90名，使用結構性問卷『泌尿護理人員提供病患性衛教面臨的問題及需要的協助』進行資料收集，以SPSS for Windows 進行資料處理與統計分析。
研究結果指出大多數護理人員是因病患提出性問題時才與之討論，主動評估病患的性衛教需要而給予性衛教者僅佔少數﹐護理人員提供病患的性衛教仍待加強。因素分析結果歸類出護理人員提供病患性衛教時，面臨來自於病患的反應、環境互動與護理人員準備度等三方面的問題，其中環境互動層面的問題是泌尿科護理人員提供病患性衛教中最常面臨、最為困擾，且最需要協助的部份。護理人員提供病患性衛教面臨問題發生頻率較高的前三項依序為(1)性衛教成效不易追蹤或評值，(2)未建立信任關係通常無法有深入的討論，以及(3)病患不敢吐露他對性方面的疑問；困擾程度較高的前三項問題依次為(1)性衛教成效的評值或追蹤不易，(2)沒有足夠或適當的性衛教資料、教材，以及(3)缺乏安靜、隱私的環境；需要協助的程度較高的前三項問題依次為(1)沒有足夠或適當的性衛教資料、教材，(2)性的衛教層面太廣且複雜，自己不易獨立完成，以及(3)性衛教成效不易評值或追蹤。
逐步複迴歸分析結果發現，護理人員提供病患性衛教面臨問題發生頻率的重要預測變項為『提供性衛教的準備度』、『護理工作總年資』與『提供性衛教積極程度』，可解釋迴歸模式21%變異量；護理人員提供病患性衛教面臨問題困擾程度的重要預測變項為『提供性衛教準備度』﹐可解釋迴歸模式6%變異量；護理人員提供病患性衛教面臨問題需要協助程度重要預測變項為『提供性衛教的準備度』以及『護理工作總年資』﹐可解釋迴歸模式11%變異量。
本研究結果提供泌尿科護理人員於病患性衛教護理情境面臨的問題與需要協助的情形，並作為護理教育及臨床在職教育課程安排之參考，對提升性衛教護理品質有很大的助益。

英文摘要(Abstract)
Human sexuality is an integral part of health care, nurses consider it as a part of their role as a nurse and integrate sexual health care into the holistic care. Previous research has shown that patients'' sexual health care is frequently neglected of nursing practices. It revels that to investigate the barriers and interference nursing process of patients sexual health care is very important. In past years, either overseas studies or civil studies had focused on nurses'' knowledge of and attitudes towards sexuality and the relationship of these with nursing practice, and never about the urology. This study investigated the problems and needs experienced by urology nurses on delivery sexual health teaching of patients care and related factors, and it could be a basic data and information by further improvement of clinical nursing practice or educational programs, then promote the quality of patients sexual health care.
This study used a cross-section survey method and purposive sampling. A total of 90 urology nurses who worked at a medical center hospital in north Taiwan and had been employed for more then three months were selected. Date was collected by a list of 26 items based on former research, in order to explore the problems and needs experienced by urology nurses'' on delivery sexual health teaching of patients care, which were self-administered by subjects. Date was processed by SPSS for Windows software.
This study reveals the major of urology nurses provided sexual health teaching when patients asked sexual problems. Factor analyses resulted in a 3-factor structure with the problems connotation that experienced by urology nurses on delivery sexual health teaching of patients care, which included three factors were related to patients'' reaction, related to relationship and environment, relation to nurses'' provision. The relationship and environment were the major frequent, disturbance, and needs problems experienced by urology nurses on sexual health teaching. The highest frequently problem was "It is difficult to evaluated or follow up sexual health teaching", the 2nd frequently problem was "Neither the trust relationship between nurses and patients, nor furthermore dissuasion", the 3rd frequently problem was "Patients were hesitated to express their sexual problems"；The highest disturbance problem was "It is difficult to evaluated or follow up sexual health teaching", the 2nd disturbance problem was " there was insufficient information for sexual teaching" ,and the 3rd disturbance problem was " lack of quite and privacy site for addressed sexual issues with patients；The highest need of assist to deal with the problem was " there was insufficient information for sexual teaching", the 2nd need of assist to deal with the problem was "Urology nurses perceived that the most sexual problems were too complex to be within the realm of nursing practice", and the 3rd problem need of assist to deal with the problem was "" It is difficult to evaluated or follow up sexual health teaching".
Stepwise multiple regression analyses demonstrated the provision of providing sexual teaching, years of nursing services, and the positive degree of providing, were significant variables related to the frequency of the problems experienced by urology nurses on delivery sexual health teaching of patients care, accounting for 21% of the variance. The provisions of providing sexual teach, was significant variable related to the disturbance degree of experienced by urology nurses on delivery sexual health teaching of patients care, accounting for 6% of the variance. The provision of providing sexual teaching and years of nursing service were related to the needs of assist to deal with problems of experienced by urology nurses on delivery sexual health teaching of patients care, accounting for 11% of the variance.
The result of this study may provide an information for understanding the problems and needs as urology nurses on delivery sexual health teaching of patients care. It is a good prior reference for nursing curriculum or continuous education programs, by further making modification to raise the quality of sexual health care for patients.
Key word：urology nurses, sexual health teaching , problems and
needs

目錄
頁次
致 謝--------------------------------------------------- Ⅰ
論文摘要---------------------------------------------------
英文摘要---------------------------------------------------
內容目錄---------------------------------------------------Ⅲ
圖表目錄--------------------------------------------------- Ⅳ
第一章 緒論1
第一節 研究動機及目的------------------------------ 2
第二節 研究問題與研究假設----------------------- 4
第三節 名詞界定---------------------------------------- 5
第二章 文獻查證
第一節 人類性學與發展史--------------------------6
第二節 性健康照護的護理發展------------------- 7
第三節 護理人員在病患性健康照護的專業角色 8
第四節 護理人員題翁病患的性健康照護行為與影響因素------11
第五節 護理人員提供性健康照護面臨的問題----------------13
第六節 護理人員提供性健康照護的需求--------------------15
第三章 研究方法
第一節 研究設計----------------------------------------18
第二節 研究對象與場所----------------------------------19
第三節 研究工具----------------------------------------19
第四節 研究工具的信效度檢定---------------------------- 21
第五節 資料收集過程------------------------------------23
第六節 資料處理與統計分析------------------------------24
第七節 倫理考量----------------------------------------25
第四章 研究結果
第一節 護理人員背景資料分佈情形------------------------30
第二節 護理人員提供病患性衛教面臨的問題與問題發生的頻率40
第三節 護理人員提供病患性衛教面臨問題的困擾程度--------42
第四節 護理人員提供病患性衛教需要協助的程度------------44
第五節 護理人員提供病患性衛教面臨問題的發生頻率、困擾程
度與需要協助的程度之影響因素--------------------52
第五章 討論
第一節 護理人員提供病患性衛教的處理方式----------------61
第二節 護理人員提供病患性衛教面臨的問題與需要的協助----64
第三節 護理人員提供病患性衛教面臨問題的發生頻率、困擾程
度與需要協助的程度與相關影響因素----------------71
第六章 結論與建議
第一節 結論--------------------------------------------75
第二節 護理上的應用------------------------------------77
第三節 研究限制與建議----------------------------------78
參考資料
中文部份------------------------------------------------80
英文部份------------------------------------------------82
附錄
附錄一 問卷內容效度專家名單----------------------------87
附錄二 致護理人員之書面說明及同意書--------------------88
附錄三 研究問卷----------------------------------------89
圖表目錄
頁次
圖3-1 研究的概念架構--------------------------------------18
表3-1 護理人員提供病患性衛教面臨問題的發生頻率量表之因素分
析結果----------------------------------------------26
表3-2 護理人員提供病患性衛教面臨問題的困擾程度量表之因素分
析結果----------------------------------------------27
表3-3 護理人員提供病患性衛教面臨問題需要協助的程度量表之因
素分析結果------------------------------------------28
表3-4 研究工具之內在一致性信度與穩定信度------------------29
表4-1-1 護理人員基本屬性分佈--------------------------------34
表4-1-2 護理人員曾經界受過的性學教育課程--------------------35
表4-1-3 不同醫院等級護理人員的基本屬性之差異分析------------36
表4-1-4 護理人員對提供性衛教的觀點--------------------------37
表4-1-5 病患詢問以及護理人員提供的性衛教內容----------------37
表4-1-6 護理人員提供性衛教的執行方式------------------------38
表4-2-1 護理人員提供病患性衛教面臨的問題--------------------46
表4-2-2 護理人員提供病患性衛教面臨問題的人次排行榜----------47
表4-2-3 護理人員提供病患性衛教面臨問題的發生頻率、困擾程度與
需要協助的程度各方面之得分--------------------------46
表4-2-4護理人員提供性衛教面臨問題的發生頻率之得分及排行榜--48表4-3-1 護理人員提供性衛教面臨問題的困擾程度之得分及排行榜--49表4-4-1護理人員提供性衛教面臨問題需要協助的程度之得分及排行
榜--------------------------------------------------48
表4-5-1 護理人員基本屬性、對性衛教觀點與提供性衛教準備度之相
關的影響--------------------------------------------56
表4-5-2 護理人員教育、宗教及提供性衛教準備度與問題的發生頻率
、困擾程度、需要的協助間之差異性分析----------------57
表4-5-3 護理人員基本屬性、對性衛教觀點及性衛教準備度與問題的
發生頻率、困擾程度、需要的協助間之相關性-------------58
表4-5-4 護理人員提供病患性衛教面臨問題發生頻率的逐步迴歸分析59
表4-5-5 護理人員提供病患性衛教面臨問題困擾程度之逐步回歸分析59
表4-5-5 護理人員提供病患性衛教面臨問題需要協助的程度之逐步回
歸分析-----------------------------------------------59

參考資料
中文部份：
吳麗芬（民72）·護理人員性知識、態度與專業行為之研究 ·護理雜誌，30，43-51。
李選、徐麗華、黃曉黎（民86）·性諮商的運用與展望 ·護理雜誌，44，61-67。
李選﹙民83﹚·性諮商與臨床應用·長庚護理，5，4-10。
阮芳賦（民84）·性育芻議 ·台灣性學學刊，1，10-12。
林文香、夏萍絅 ﹙民87﹚·女性護理人員面對男病患性騷擾及其看法·公共衛生，25，167-178。
施瑞珍（民75）·泌尿科病人的性問題及其調適方法 ·護理雜誌，33，87-91。
晏涵文（民71）·護理、家計人員性知識、態度與專業「性角色」行為研究 ·台北：署光。
馬先芝、駱麗華（民82）·探討膀胱癌病人所關心的性問題 ·護理研究，1，176-186。
高紀惠（民67）·某醫院婦科手術病人所擔心的房事問題之探討 ·護理雜誌 ， 25，75-81。
張玨、毛家舲、陳寶雲、張菊惠（民84）·都會地區中年婦女的月經經驗與性發展 ·婦女與兩性學刊，6，55-75。
湯美霞（民86）·精神科護理人員性知識、態度及處理病患性問題方式與自信程度之探討 ·國立台灣大學護理研究所碩士論文。
黃翠媛、黃秀梨（民84）·人類性學概要 ·護理雜誌，42，92-97。
黃正宜（民86）·護理人員對心肌梗塞病人性生活方面的認知、態度與護理行為極其相關因素之探討 ·國立台灣大學護理研究所碩士論文。
蔡勇美、江吉芳（民79）·性的社會觀 ·台北：巨流。
鄭素月﹙民67﹚·護理人員對住院病人衛教情況之調查研究·護理雜誌，25，51-62。
英文部份：
Anderson, M. L. (1980). Talking about sex-without less anxity. Journal of psychiatric nursing and mental health services, 18, 10-15.
Annon, J. S. (1976). The PLISSIT Model : A proposed conceptual scheme for the Behavioral treatment of sexual problems. Journal of Sex and Education Therapy, 2, 1-5.
Baggs, J. C., & Karch, A. M. (1987). Sexual counseling of women with coronary heart disease. Heart and Lung, 16, 154-159.
Borwell, B. (1997). The psychosexual needs of stoma patients. Professiona Nurse, 12, 250-255.
Campsey, J. R. (1985). The sexual dimention of patient care. Nursing Forum, 22, 69-71.
Chicano, L. A. (1989). Humanistic aspects of sexuality as related to spinal cord injury. American Association of Neuroscience Nurses, 21,366-369.
Damrosch, S. P. (1981). Nursing student''s attitudes toward sexually active older persaons. Nursing Research, 31, 252-255.
Ekland, M., & McBride, K. (1997). Sexual health care:The role of the nurse. Canadian Nursing, 93, 34-37.
Elder, M. S. (1970). Nursing counseling on sexuality. Nursing Outlook, 18, 38-40.
Falk, G., & Falk, U. A. (1980). Sexuality and the aging. Nursing outlook, 28, 51-55.
Fogel, C. I. (1990). Human sexuality and health care. In C. I. Fogel., & D.
Lauver. (Eds.), Sexual Health Promotion. (pp.1-18). Philadelphia : W. B. Saunders.
Fontain, K. L. (1991). Unlocking sexual ssues:Counseling strategies for nurses.
Nursing Clinics of North American, 26, 737-743.
Gamel, C., & Davis, B. D. (1993). Nurses'' provision of teaching and counseling on sexuality : a review of the literature. Journal of Advanced Nursing, 18 ,1219-1217.
Gamel, C., Hangeveld, M. W., Davis, B., & Tweel, I. V. (1995). Factors that influence the provision of sexual health care by Dutch nurse. International Journal of Nursing Studies, 32, 301-314.
Goldsborough, J. D. (1970). On becoming nonjudgemental . American Journal of Nursing, 70, 2340-2343.
Grigg, E. (1997). Guidelines for teaching about sexuality. Nurse Education Today, 17, 62-66.
Hogan, R. (1980). Human sexuality: A nursing perspective. New York: Appleton-Century-Crofts.
Hughes, M. K. (1996). Sexuality Issues : Keeping your control. Oncology Nursing Forum, 23, 1597-1600.
Irwin, R. (1997). Sexual health promotion and nursing. Journal of Advanced Nursing, 25, 170-177.
Jacobson, L. (1974). Illness and human sexuality. Nursing Outlook, 22, 50-53.
Johnson, R. W. (1970). Sex education and the nurse. Nursing Outlook, 18, 26-29.
Johnson, B. K. (1996). Older adults and sexuality:A multdimensional perspective. Journal of Gerontological Nursing, 22, 6-15.
Kautz, D., Dickey, C. A., & Stevens, M. N. (1990). Using research to identify why nurses do not meet established sexuality nursing care standards. Journal of Nursing Quality Assurance, 4, 69-78.
Kolodny, R. C., Masters, W. H., Johnson, V. E., & Biggs, M. A. (1979). Textbook of Human Sexuality for Nurses. Louis Missouri : Little, Brown and Company Boston.
Lewis, S. & Bor, R. (1994). Nurses'' knowledge of and attitudes towards sexuality and the relationship of these with nursing practice. Journal of Advanced Nursing, 20, 251-259.
Lief, H. I., & Payne, T. (1975). Sexuality-knowledge and attitudes. American Journal of Nursing, 75, 2026-2029.
Master, W. H. & Johnson, V. E. (1966). Human sexual response. Boston：Little & Brown.
Matocha, L. K., & Waterhouse, J. K. (1993). Current nursing practice related to sexuality. Research in Nursing & Health, 16, 371-378.
Metz, M. E., & Seifert, M. H. (1990). Ｍen''s expectations of physicians in sexual health concern. Journal of Sex and Material Therapy, 16, 79-88.
Miller, S. (1984). Recognizing the sexua health care needs of hospitalized patients. Canadian Nurse, 80, 43-46.
Mims, F. H. (1977). Sexuality in the nursing curriculum. Nurse Educator, 2, 20-23.
Palmer, H. (1998). Exploring sexuality and sexual health in nursing. Professional Nurse, 14, 15-17.
Payne, T. (1976). Sexuality of nurses : correlations of knowledge, attitudes, and behavior. Nursing Research, 25, 286-292.
Renshaw, D. C. (1975). Nurse need formal sex education. Journal
Of Nursing Education, 14, 16-19.
Russell, P. (1998). Sexuality in the lives of older people. Nursing Standard,13, 49-53.
Shuman, N. A., & Bohachick, P. (1987). Nurses'' Attitudes towards sexual counseling. Dimentions of Critical Care Nursing, 6, 75-81.
Smith, D. B. (1989). Sexuality rehabilitation of the cancer patient. Cancer Nursing,12, 10-15.
Steinke, E. E., & Patterson-Midgley, P. E. (1995). Sexual counseling of MI patients by cardiac nursrs. The Journal of Cardiovascular Nursing, 10, 81-87.
Steinke, E. E., & Patterson-Midgley, P. E. (1996). Sexual counseling of MI patients: Nurses'' comfort, responsibility, and practice. Dimensions of Critical Care Nursing, 15, 216-223.
Steinke, E. E., & Patterson-Midgley, P. E. (1998). Perspectives of nurses and patients on the need for sexual counsealing of MI patients. Rehabilitatio n Nursing, 23, 64-70.
Waterhouse, J., & Metcalfe, M. (1991). Attitudes toward nurses discussing sexual concerns with patients. Journal of Advanced Nursing, 16, 1048-1054.
Watts, R. J. (1979). Dimensions of sexual health. American Journal of Nursing, 9, 1568-1572.
Waxman, E. S. (1993). Sexual dysfunction following treatment for prostate cancer : Nursing assessment and interventions. Oncology Nursing Forum, 20, 1567-1571.
Webb, C. (1988). A study of nurses'' knowledge and attitudes about sexuality in health care. International Journal of Nursing studies, 25, 235-244.
Weinberg, J. S. (1982). Sexuality: Human needs and nursing practice. Philadelphia:W.S. Saunders.
Weston, A. (1993). Challenging assumptions. Nursing Time, 89, 26-29.
Wilson, M. E., & Williams, H. A. (1988). Oncology nurses'' attitudes and behaviors related to sexuality of patients with cancer. Oncology Nursing Forum, 15, 49-53.
Woods, N. F. (1984). Human Sexuality. (3rd). Louis : C. V. Mosby.
World Health Organization. (1975). Education and Treatment in Human Sexuality : The Training of Health Professionals. Technical Report Series (No.572) Geneva: Author.