臺灣博碩士論文加值系統

尿失禁是老年人普遍、難以啟齒的問題，更是老人住進長期照護機構的重要原因之一，如無適當的處置會對老人生理、心理及社會等層面造成衝擊，因此，了解護理人員尿失禁照護的知識、態度及行為，將有助於提升老年人尿失禁的照護品質。本研究目的在探討長期機構照護護理人員尿失禁照護知識、態度及行為之情況。本研究採類聚性選樣（Cluster Sampling）方式，以台南縣市、高雄縣市及屏東縣市政府立案的公私立安養護機構、護理之家及榮民之家等，共57家機構251位護理人員為研究對象，共得有效問卷233份。研究工具採結構式問卷，包括基本資料、老年人尿失禁照護知識量表、老年人尿失禁照護態度量表及老年人尿失禁照護行為量表。所得資料以SPSS/Window10.1套裝軟體進行描述性及推論性統計分析。
研究結果發現：機構護理人員在老年人尿失禁照護知識整體答對率為82.3%，而以排尿機轉知識認知最差，為66.7%。整體尿失禁照護知識受到單位性質影響，即護理之家之護理人員知識較養護中心之護理人員佳；機構護理人員在整體老年人尿失禁照護偏正向態度，護理人員能認同機構尿失禁是重要議題，但42.5%-45%的人認為尿失禁的老人身上常有一股尿騷味而讓人不想接近，及定時協助活動不便老人如廁會增加工作負擔等負向感受，且61%的人以包尿布來解決尿失禁問題之負向行動傾向；整體老年人尿失禁照護態度受教育程度影響。護理人員僅「偶而」到「經常」執行尿失禁照護行為，41.8%的機構護理人員於臨床實務中無評估分辨尿失禁類型，且僅39-65%的護理人員會給予骨盆底肌肉運動、膀胱訓練或如廁訓練等處置，42%-78%的護理人員針對認知損傷及活動不便老人，仍以包尿布為最主要的護理措施，以上整體尿失禁照護行為受年齡、與老人同住時間、護理工作總年資等因素影響。尿失禁照護知識與照護態度具有顯著的正相關（r＝.246，p＜.000），尿失禁照護知識與尿失禁評估行為呈現正相關（r＝.192，p＜.05），尿失禁照護態度與照護行為亦具有顯著的正相關（r=.298，p＜.000）。本研究結果可作為護理實務、護理行政及護理教育等方面之參考依據，並作為機構主管擬訂在職教育及改善尿失禁照護政策之依據，最終達到提升機構中護理人對尿失禁老人之照護品質。

The purpose of this study was to explore the nurses’ caring knowledge, attitude, and behavior toward elderly urinary-incontinence in long-term care facilitates nurses. The study used cluster sampling method. The subjects was used to collect totally 233 valid questionnaires of 250 nurses from 57 long-term care facilitates in Kaohsiung County, Kaohsiung City, Tainan County, Tainan City, Pington County, and Pington City. A structural questionnaire developed by researcher including the demographic, and the nurses’ caring knowledge toward elderly urinary-incontinence, and the nurses’ caring attitude toward elderly urinary-incontinence, and the nurses’ caring behavior toward elderly urinary-incontinence. The results were analyzed by the methods of descriptive and inferential statistics.
The results show the following: the rate of accurate replies in the institutionalized nurses’ caring knowledge about elderly urinary-incontinence is 82.3%, the lowest correct response rate is 66.7%, which was the knowledge of urinary mechanism. The characteristics of the institutes were significantly related to the overall knowledge of the nurse about elderly urinary-incontinence. Most nurses have bias toward positive attitude to elderly urinary-incontinence and admit that urinary-incontinence of institutionalized elderly patients is a crucial problem. However, 42.5%-45% of the nurses dislike getting close to elderly patients who suffer from urinary incontinence because of the foul odor of urine on their bodies, and admit that assisting immobile elderly patients to go to toilet regularly increase their work load. Moreover, 61% of the nurses prefer using adult diaper garments to deal with the problem of urinary-incontinence. The overall attitude toward nurses’ caring of elderly urinary-incontinence is influenced by educational level. Only “occasional” and “frequent” were used to describe the behavior toward nurses’ caring of elderly urinary-incontinence. 41.8% of the nurses don’t assessment the type of urinary-incontinence. Only 39-65% of the nurses teach elderly patients Kegel’s excise，bladder training and toileting assistance . 42-78% of the nurses handled elderly patients with impaired cognition and immobility by using adult diaper garments. The nurses’ caring behavior for elderly urinary-incontinence is influenced by age, duration of living with elderly people, number of years working in the nursing field. Knowledge of elderly urinary-incontinence and attitude toward elderly urinary-incontinence are positively correlated（r=.246，p＜.000）.Knowledge of elderly urinary-incontinence and assessment behavior for elderly urinary-incontinence are positively correlated（r=.192，p＜.05）. Attitude toward elderly urinary-incontinence and behavior toward elderly urinary-incontinence are positively correlated（r=.298，p＜.000）. The result of this study provides excellent references for clinical nursing practice, nursing administration and nursing education. It also helps to improve training in nursing care for urinary-incontinence and policy-making in long-term care facilitates This may eventually lead to better nursing care quality for urinary-incontinence.

目錄
頁次
致謝 ---------------------------------------------------------------------------- i
摘要 ---------------------------------------------------------------------------- ii
Abstract ------------------------------------------------------------------------- iv
目錄 ---------------------------------------------------------------------------- vii
圖表目次 ---------------------------------------------------------------------- x
第一章 緒論------------------------------------------------------------------- 1
第一節 研究動機及重要性------------------------------------------- 1
第二節 研究目的------------------------------------------------------- 4
第三節 名詞界定------------------------------------------------------- 5
第二章 文獻查證------------------------------------------------------------- 7
第一節 控尿及排尿機轉---------------------------------------------- 8
第二節 老年人尿失禁概述------------------------------------------- 10
第三節 護理人員老年人尿失禁照護知識及相關性------------- 22
第四節 護理人員老年人尿失禁照護態度及相關性------------- 25
第五節 護理人員老年人尿失禁照護行為及相關性------------- 28
第三章 研究架構------------------------------------------------------------- 31
第四章 研究方法------------------------------------------------------------- 32
第一節 研究對象及選樣---------------------------------------------- 33
第二節 倫理考量------------------------------------------------------- 35
第三節 研究工具------------------------------------------------------- 36
第四節 研究步驟------------------------------------------------------- 43
第五節 資料處理與分析---------------------------------------------- 45
第五章 研究結果------------------------------------------------------------- 46
第一節 機構護理人員基本屬性------------------------------------- 47
第二節 護理人員老年人尿失禁照護知識與相關因素---------- 50
第三節 護理人員老年人尿失禁照護態度與相關因素---------- 61
第四節 護理人員老年人尿失禁照護行為與相關因素---------- 72
第五節 護理人員老年人尿失禁照護知識、態度與行為
之相關性------------------------------------------------------- 80
第六章 討論------------------------------------------------------------------- 83
第一節 護理人員老年人尿失禁照護知識與相關因素---------- 84
第二節 護理人員老年人尿失禁照護態度與相關因素---------- 90
第三節 護理人員老年人尿失禁照護行為與相關因素---------- 95
第四節 護理人員老年人尿失禁照護知識、態度與行為
之相關性------------------------------------------------------- 99
第七章 結論與建議---------------------------------------------------------- 102
第一節 結論------------------------------------------------------------ 103
第二節 建議------------------------------------------------------------ 107
第三節 研究限制及建議--------------------------------------------- 112
參考資料----------------------------------------------------------------------- 114
中文文獻 ---------------------------------------------------------------- 114
英文文獻 ---------------------------------------------------------------- 116
附錄一 研究說明暨研究同意書---------------------------------------- 125
附錄二 研究工具---------------------------------------------------------- 126
附錄三 專家效度名單---------------------------------------------------- 135


圖表目次
表列 頁次
表4-1 各縣市機構、護理人員數情形------------------------------------ 34
表4-2 老年人尿失禁照護知識、態度及行為量表之Content Validity Index-------------------------------------------------------------------- 40
表4-3 護理人員老年人尿失禁照護知識量表之信度------------------ 42
表4-4 護理人員老年人尿失禁照護態度、行為量表之信度--------- 42
表5-1 基本屬性資料分佈與百分比之情形------------------------------ 49
表5-2 護理人員老年人尿失禁照護知識得分情形--------------------- 53
表5-3 基本資料在護理人員老年人尿失禁照護知識之差異分析--- 57
表5-4 基本資料在護理人員老年人尿失禁照護知識之差異分析--- 58
表5-5 基本資料在護理人員老年人尿失禁照護知識之差異--------- 59
表5-6 護理人員老年人尿失禁照護知識與基本屬性之Pearson’s correlation 分析------------------------------------------------------- 60
表5-7 護理人員老年人尿失禁照護態度得分情形--------------------- 64
表5-8 基本資料在護理人員老年人尿失禁照護態度之差異分析--- 67
表5-9 基本資料在護理人員老年人尿失禁照護態度之差異分析--- 68
表5-10 基本資料在護理人員老年人尿失禁照護態度之差異分析--- 69
表5-11 基本資料在護理人員老年人尿失禁照護態度之差異分析--- 70
表5-12 護理人員老年人尿失禁照護態度與基本屬性之Pearson’s correlation 分析------------------------------------------------------- 71
表5-13 護理人員老年人尿失禁照護行為得分情形--------------------- 75
表5-14 護理人員老年人尿失禁照護行為與基本屬性之Pearson’s correlation 分析------------------------------------------------------- 77
表5-15 基本資料在護理人員老年人尿失禁照護行為之差異分析--- 78
表5-16 基本資料在護理人員老年人尿失禁照護行為之差異分析--- 79
表5-17 護理人員整體老年人尿失禁照護知識、態度及行為之Pearson’s correlation ------------------------------------------------------------- 82
表5-18 尿失禁照護知識與照護態度各分項之Pearson’s correlation 分析--------------------------------------------------------------------------- 82
表5-19 尿失禁照護知識與照護行為各分項之Pearson’s correlation 分析--------------------------------------------------------------------------- 82
表5-20 尿失禁照護行為與照護態度各分項之Pearson’s correlation 分析--------------------------------------------------------------------------- 82

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