跳到主要內容

臺灣博碩士論文加值系統

(44.200.27.215) 您好!臺灣時間:2024/04/24 17:42
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:游素英
研究生(外文):SU-YING YU
論文名稱:探討某癌症醫院的腫瘤專科護理師對遵從疼痛臨床照護指引的現況及其影響因素
論文名稱(外文):The Exploration of Adherence to the Clinical Practice Guidelines on the Management of Cancer Pain by Oncology Nurse Practitioners - Current Status and Its Related Factors
指導教授:陳月枝陳月枝引用關係
指導教授(外文):YUEH-CHIH CHEN
口試委員:張黎露雷若莉
口試委員(外文):LI-LU CHANGRUOH-LIH LEI
口試日期:2015-05-27
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:102
中文關鍵詞:專科護理師癌症疼痛照護指引遵從
外文關鍵詞:Nurse practitionersCancer pain control guidelinesAdherence
相關次數:
  • 被引用被引用:0
  • 點閱點閱:390
  • 評分評分:
  • 下載下載:111
  • 收藏至我的研究室書目清單書目收藏:3
癌症一直是國人十大死因的第一位,在臺灣最大規模的癌症疼痛調查結果提到有62.4%的病人曾經歷不同程度的疼痛,且有疼痛控制不良的問題(陳等,2007),而癌症疼痛控制不足的原因最主要是醫療專業人員的知識不足以及未遵從疼痛照護指引的建議 (American Society of Clinical Oncology , 2013 )。 然而,遵從疼痛照護指引的問題ㄧ直是醫護界所需共同克服的障礙,而在國內針對影響臨床專業人員對指引遵從的研究相當有限,因此本研究是要探討腫瘤專科護理師癌症疼痛控制的知識以及對癌症疼痛臨床照護指引的遵從意願和相關影響因素,期待能作為未來改善疼痛控制的參考。
本研究為橫斷式相關性研究,採立意取樣收案,於103年9月調查北區某癌症中心的腫瘤科專科護理師共49位,以問卷調查的方式,調查專科護理師的疼痛控制的知識以及對疼痛指引的遵從意願和對臨床照護指引遵從的相關影響因素。研究結果發現在疼痛控制知識部份答對率有超過七成,其中以癌症疼痛用藥原則的知識優於癌症疼痛開藥實務的知識,而腫瘤專科護理師的基本屬性如教育程度、科別、年資和職級與癌症疼痛控制知識的高低無關聯。另外,有93.4 %的專科護理師願意遵從醫院所制定的癌症疼痛照護指引,常見無法遵從的內容為硬膜外腔止痛,最願意遵從的指引內容為Opioids 副作用處理,其遵從意願與專科護理師科別、教育程度、年資、職級和癌症疼痛控制知識高低沒有顯著關聯,但非腫瘤科的專科護理師年資多寡,與對醫院所制定的疼痛指引的遵從意願具有關聯性 (p = .00)。在影響腫瘤專科護理師對遵從疼痛照護指引的影響因素部份,最常見的前三項影響因素依序為『疼痛臨床照護指引的建議應符合保險給付制度』、『工作場合缺乏疼痛控制的教育資料』和『對制定疼痛照護指引的醫療團隊有信心』,其相關影響因素分析發現科別以腫瘤內科的專科護理師受行為方面的影響較多( p = .01 )。 另外,專科護理師年資多寡對於指引遵從的影響在行為層面的影響也有顯著差異 ( p = .00 ); 非腫瘤科的的專科護理師年資多寡受指引遵從的影響在態度方面有顯著差異 (p = .04);專科護理師的教育程度對指引遵從的影響,受行為方面影響最大 (p = .00),其他如專科護理師的護理年資和職級對指引遵從的知識、態度和行為方面皆無顯著影響。另外,腫瘤專科護理師癌症疼痛控制的知識與指引遵從的影響因素包括知識、態度和行為影響因素並無相關性,但影響指引遵從的知識、態度和行為因素三者之間具有中度的相關性,且有統計意義。腫瘤專科護理師的科別、教育程度、專科護理師年資、其它科別的專科護理師年資對指引遵從的影響,其解釋力為46.3%,其中以教育程度的預測性最高,解釋力為20.6%,而腫瘤科專科護理師的年資對指引遵從的解釋力為15.3%。
此研究結論發現專科護理師對癌症疼痛控制的開藥實務知識以及對疼痛照護指引的遵從性仍需加強,針對促進專科護理師對指引的遵從意願部分,建議宣導專科護理師有關醫院所制訂的癌症疼痛照護指引,針對內容的疑慮和作法予以澄清及解釋以增加專科護理師的遵從意願;針對克服和改善專科護理師影響對指引的遵從部分,建議改善臨床環境、加強行為層面的改善包括視需要隨時更新指引的內容以符合臨床的適切性,提高醫療專業人員的使用意願,以促進全面性疼痛控制的照護品質。

關鍵詞:專科護理師、癌症疼痛照護指引、遵從

Cancer has always been the number one killer in Taiwan out of the top ten causes of death. In the largest research study on cancer pain conducted in Taiwan, 62.4% of patients experienced different degrees of pain and problems associated with the inability to control pain (Chen, et al., 2007). Some reasons for this inability to control cancer pain originate from a lack of clinician’s knowledge as well as failure to follow cancer pain control guidelines recommended by the American Society of Clinical Oncology in 2013. Therefore, the ques-tion of adherence to cancer pain control guidelines has always been a challenge that the healthcare community needs to overcome. Domestically, there is limited research on how to better direct and influence clinical professionals toward adherence. Therefore, this research seeks to study the relationship between knowledge of oncology nurse practitioners and the willingness to adhere to guidelines including related factors when treating cancer pain and contribute to literature on how to improve pain control.
This study adopted a cross-section descriptive survey and purposive sampling. In Sep-tember 2014, 49 oncology nurse practitioners from an oncology center in the northern district of Taipei were surveyed using a questionnaire. The study focused on the pain control knowledge of specialist nurses and the willingness to adhere to guidelines and the effects of related factors in adhering to guidelines in clinical care. Results from the study found that more than 70% answered correctly on questions about pharmacological management of can-cer pain. It was found that administering pain medication principle subscale outperformed administering pain medication practice subscale. It was found that the disposition and educa-tion level of oncology nurse practitioners along with their research on cancer pain outper-formed others with similar education levels. Additionally, nurses who graduated from voca-tional nursing schools performed worst in their knowledge about cancer pain control and principles of medication, with a statistical significance. The variables such as their major in school, salary, professional status did not have any correlation with cancer pain control knowledge.
Moreover, 93.4% of nurse practitioners are willing to follow cancer pain control guide-lines defined by hospitals. The most common reasons for not adhering to the guidelines is epidural analgesia. The most reason for adhering to the guidelines is opioids of side effects. There was no correlation between the department, education level, salary or professional sta-tus nurse practitioners in cancer pain control knowledge. The work experience variable of nurse practitioners from other departments made a difference (p= .00). The three most com-mon factors that influence oncology nurse practitioners with regard to adherence to guidelines are were whether recommendations for cancer pain control guidelines conformed to the in-surance payment system, whether the work environment lacked pain control education mate-rials, and the confidence level of the pain control medical team. The practice of nurse practi-tioners in internal medicine of oncology have a greater effect than surgical oncology, with a statistical significance of p=.01. The biggest effect was seen in the area of practice (p=.00), especially in participants with work experience between 1-5 years and 6-10 years. The work experience variable of nurse practitioners from other departments also made a difference (p=.04). Additionally, there was a positive correlation between the effect of oncology nurse practitioners’ knowledge of cancer pain control and adherence to guidelines, meaning the more knowledge the nurses had about cancer pain control, the lower its effect on the adher-ence to guidelines, and the effect of knowledge on adherence, attitude and practice showed medium correlations. The education levels of nurse practitioners , oncology nurse practitio-ners experience, others nurse practitioners experience and Department can explained about guidelines adherence 46.3%.Research findings conclude that nurse practitioners need to increase their knowledge about pharmacological management of cancer pain – practical subscale. In the area of over-coming and improving nurse practitioners’ propensity to follow guidelines, practice en-hancements should first be made and hospitals need to keep the contents of the guidelines updated so they can be applied to and are suitable for clinics. This will increase the willing-ness by medical staff to use them, thereby elevating the quality of pain control overall.

Keyword:Nurse practitioners、Cancer pain control guidelines、Adherence

VII
目 錄
誌謝……………………………………………………………………………………I
中文摘要………………………………………………………………………………III
英文摘要………………………………………………………………………………V
目錄……………………………………………………………………………………VII
參考文獻………………………………………………………………………………IX
附錄……………………………………………………………………………………X
表目錄…………………………………………………………………………………X
圖目錄…………………………………………………………………………………XI
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……………………………………………………………………3
第三節 研究問題……………………………………………………………………4
第四節 研究假設……………………………………………………………………5
第五節 名詞界定……………………………………………………………………6
第二章 文獻探討……………………………………………………………………11
第一節 癌症疼痛……………………………………………………………………11
一 、癌症疼痛控制的影響因素……………………………………………………11
二 、癌症疼痛控制…………………………………………………………………12
三 、癌症疼痛控制的相關研究……………………………………………………13
第二節 癌症疼痛照護指引…………………………………………………………14
一 、癌症疼痛照護指引之發展與現況……………………………………………14
二 、臨床專業人員遵從癌症疼痛照護指引的重要性……………………………15
三 、影響專業人員使用臨床照護指引的障礙因素………………………………16
四 、影響專業人員遵從臨床照護指引的障礙因素之相關研究…………………18
五 、促進臨床照護指引遵從的因素以及相關研究………………………………18
第三節 美國專科護理師的發展及其在癌症疼痛控制的角色及功能……………20
第四節 台灣專科護理師的發展及其在癌症疼痛控制的角色及功能……………21
第三章 研究方法……………………………………………………………………23
第一節 研究設計……………………………………………………………………23
第二節 研究架構……………………………………………………………………24
第三節 研究對象……………………………………………………………………25
第四節 研究工具……………………………………………………………………26
第五節 研究步驟……………………………………………………………………28
第六節 資料收集與處理……………………………………………………………29
第四章 研究結果……………………………………………………………………33
第一節 研究對象之基本屬性………………………………………………………33
第二節 腫瘤專科護理師癌症疼痛控制的知識……………………………………35
II - 1. 癌症疼痛控制的用藥原則知識 ……………………………………… 35
II - 2. 癌症疼痛控制的開藥實務知識…………………………………………35
II - 3. 癌症疼痛控制知識之相關性分析 …………………………………… 37
第三節 腫瘤專科護理師對疼痛指引的遵從意願…………………………………40
III - 1. 癌症疼痛指引的遵從意願…………………………………………… 40
III - 2. 癌症疼痛指引的遵從意願之相關性分析…………………………… 41
第四節 腫瘤專科護理師遵從癌症疼痛指引的影響因素…………………………44
IV - 1. 腫瘤專科護理師遵從癌症疼痛指引的影響因素分析…………………44
1-I. 知識因素之探討…………………………………………………………… 44
1-II. 態度因素之探討……………………………………………………………47
1-III. 行為因素之探討………………………………………………………… 48
IV - 2. 腫瘤專科護理師對指引遵從的影響因素之預測因子…………………51
IV - 3. 癌症疼痛控制知識與指引遵從的影響因素之相關性…………………52
第五章 討論…………………………………………………………………………55
第一節 探討醫護人員的癌症疼痛控制知識………………………………………55
I - 1. 機構的基本屬性………………………………………………………… 55
I - 2. 癌症疼痛控制的知識現況……………………………………………… 55
I - 3. 癌症疼痛控制知識之相關性…………………………………………… 57
I - 4. 癌症疼痛指引的使用…………………………………………………… 58
第二節 探討專科護理師對癌症疼痛指引的遵從意願………………………… 59
II - 1. 癌症疼痛指引的遵從意願…………………………………………… 59
II - 2. 癌症疼痛指引的遵從意願之相關性………………………………… 59
第三節 探討醫護人員遵從臨床照護指引的影響因素………………………… 60
III - 1. 遵從臨床照護指引的影響因素……………………………………… 60
III - 2. 專科護理師對指引遵從的影響因素之預測性……………………… 62
III - 3. 癌症疼痛控制知識與指引遵從的影響因素之相關性……………… 62
第四節 台灣腫瘤科專科護理師的發展………………………………………… 63
IV – 1. 專科護理師的教育趨向……………………………………………… 63
IV –2. 專科護理師對癌症病人的疼痛控制…………………………………… 63
第五節 研究結果對護理專業發展的貢獻…………………………………………65
第六節 本研究過程檢定的結果……………………………………………………66
第六章 結論與建議…………………………………………………………………71
第一節 結論…………………………………………………………………………71
第二節 本研究結果的應用…………………………………………………………74
第三節 研究限制與未來建議………………………………………………………75
參考文獻…………………………………………………………………………… 77
附錄………………………………………………………………………………… 87
附錄一 研究問卷……………………………………………………………………87
附錄二 審閱問卷專家名單…………………………………………………………91
附錄三 研究工具同意書……………………………………………………………92
附錄四 人體試驗委員會同意研究計畫證明書..…………………………………93
附錄五 癌症疼痛診療原則…………………………………………………………94
表目錄
表一 研究統計法…………………………………………………………………30
表二 專科護理師個人屬性次數分配和百分比…………………………………34
表三 專科護理師癌症疼痛控制的知識的得分情形……………………………36
表四 專科護理師基本屬性與癌症疼痛控制知識之差異性分析………………39
表五 專科護理師對疼痛照護指引內容的遵從意願……………………………40
表五-1 比較科別不同的專科護理師對疼痛照護指引內容的遵從意願…… 40
表六 比較專科護理師的基本屬性對醫院所制定的疼痛指引的遵從意願
的關聯性………………………………………………………………………… 43
表七 影響專科護理師對指引遵從影響因素的得分情形………………………45
表八 專科護理師的基本屬性與指引遵從影響因素的相關性分析……………46
表九 其他科的專科護理師年資對指引遵從的態度影響分析…………………47
表十 專科護理師的科別對指引遵從的行為影響分析…………………………48
表十一 專科護理師的教育程度對指引遵從的行影響分析.………………… 49
表十二 腫瘤科專科護理師的年資對指引遵從的行為影響分析.…………… 50
表十三 專科護理師的基本屬性對指引遵從意願的影響之預測性……………51
表十四 專科護理師的癌症疼痛控制知識與指引遵從的影響因素之相關性…52
表十五 專科護理師的癌症疼痛控制知識與指引遵從之相關性………………52
表十六 專科護理師對照護指引遵從的知識、態度和行為因素之相關性……53
圖目錄
圖一 影響某癌症醫院的腫瘤專科護理師對疼痛臨床照護指引的遵從性
探討之概念架構圖……………………………………………………………… 24
中文部分
中央健保局財團法人國家衛生研究院財團法人醫院評鑑暨醫療品質策進會 (2004) ‧臨床診療指引發展手冊‧台灣。
王憶嘉、林峰盛、孫維仁、林至芃(2010 )‧鴉片類藥物在癌症疼痛控制的新進展‧台灣醫學,14(4),450-454。
台灣癌症臨床研究合作組織(2007) ‧癌症疼痛處理指引台灣癌症臨床研究合作組織癌症疼痛與症狀處理委員會(Ed.) (pp. 1-1 ~ 8-4).
行政院衛生署護理及健康照護處.專科護理師諮詢委員會.取自http://www.
tnpa.org.tw/DB/Info/file/37-2.doc
李卿雲、翁靜宜、林春蘭、楊廷芬(2008)‧提昇區域醫院內科護理人員對癌症疼痛評估之改善方案‧腫瘤護理雜誌,7(1),43-53。
周幸生、黃惠美、郭素真、王靜慧、張議文(2012)‧建立成人癌症病人疼痛非藥物處置之臨床照護指引‧榮總護理,29 (2) ,145-157。
周繡玲(2011)‧臨床照護指引的發展方法‧腫瘤護理雜誌,1,15-14。
林昌誠(2005)‧臺灣地區癌症患者之疼痛控制‧北市醫學雜誌,2(5),423-428。
吳敬堂、鍾國彪、苗迺芳、王佳惠、許怡欣、張金堅、郭乃文(2005)‧影響醫師對指引認同的因素‧臺灣醫管學會,6(2),153-172。
胡易成、侯怡慧、馬素華、唐婉如、陳文(2008).北部醫學中心專科護理師對自身角色的看法.護理雜誌,55(3),31-38。
徐麗琴、林佳靜、賴裕和、陳美伶(2002)‧腫瘤護理人員對癌痛之評估及處置與相關因素探討‧新臺北護理期刊,4(2),29-38。
高以信、李楊成(2007)‧臨床醫療之癌症疼痛控制‧基層醫學,22(5),178-183。
陳月枝(2013)‧臺灣專科護理師現況與發展趨勢‧慈濟護理雜誌,12(3), 22-26。
陳貞秀、劉滄梧、蔡來蔭、徐翠霞、唐秀治(2006)‧臺灣非安寧照護下末期癌症疼痛處置的適當性‧中華民國癌症醫學會雜誌,22(1),1-29。
陳秋慧(2006)‧腫瘤進階護理之發展及現況‧腫瘤護理雜誌,5(1),37-46。
陳杰峰、王慈蜂、羅德毓、邱文達(2007)‧醫療爭議審議報導系列28,1-11。
陳幼貴、胡文郁、 陳宛榆、 羅淑芬、 陳書毓 、黃翰心 (2011) ‧成人癌症疼痛臨床照護指引‧腫瘤護理雜誌, 11, 87-127。
張美幸、王佳雯、陳玟伶、黃惠美、葉德豐 (2007)‧大學生對安寧療護知識之探討- 以某科技大學之護理系與醫管系學生為例‧醫護科技學刊,9 (2),103-113。
張黎露(2011) ‧癌症病人臨床照護指引發展背景‧腫瘤護理雜誌,11,1-3。
黃安年、陳多慕、儲寧瑋、王俞人、廖健熊、陳怡靜、華淑芳(2010)‧鴉片藥物於癌症疼痛治療的最新觀念‧安寧療護雜誌,15(2),196-205。
黃惠美、張美幸、胡中傑、謝玉玲(2006)‧癌末病人疼痛控制指標之監測‧安寧療護雜誌,11(3)。
黃惠美、郭素真、王靜 、張議文、周幸生(2012)‧建立成人癌症病人疼痛非藥物處置之臨床照護指引‧榮總護理,29(2),145-158。
曾翠華、林佳靜(2008)‧癌症疼痛‧護理雜誌,55(2),16-21。
衛生福利部統計處 (2013).國人十大死因統計.取自 http://www.mohw.
gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2747
賴裕和、陳淑卿、張綠怡、鄭素月、魏玲玲(2000)‧大學護生對癌症疼痛及麻醉性止痛藥的 信念與知識及其相關因素探討‧新臺北護理期刊,2(2),5-15。
賴裕和(2003)‧以實證為基礎的疼痛處置‧護理雜誌,50(1),29-33。
賴維淑、楊婉萍、趙可式(2009).安寧療護的教育- 護生、ㄧ般護理人員及專科護理師. 護理雜誌,56(1),11-16。
顏慧芳、邱麗文(2005)‧急重症醫護人員的疼痛處理知識與態度及相關因素‧實證護理,1(4),292-301。
賴維淑、楊婉萍、趙可式(2011)‧安寧療護的教育-護生、一般護理人員及專科護理師‧護理雜誌,56(1),11-16。
蘇小萍、陳品玲、賴允亮、林佳靜 (2009)‧安寧療護疼痛處置參考指引於癌末病患使用成效之調查‧榮總護理,21(4),364-368。



英文部分
Abrahamson, K. A., Fox, R. L., & Doebbeling, B. N. (2012). Facilitators and barriers to clin-ical practice guideline use among nurses. American Journal of Nursing, 112(7), 26-35.
Amanda, S., Yates, P., Edwards, H., Nash, R., Skerman, H., & Mccarthy, A. (2004). Barriers to effective cancer pain management: a survey of Australian family caregivers. Europe Journal of Care,13(4), 336-343.
Azevedo,S.L.F.K., Kimura, M., & Jacobsen, T.M. (2006). The WHO analgesic ladder for cancer pain control, twenty years of use: how much pain relief dose one get from using it? Supportive Cancer Care, 14(11), 1086-1093.
Borglin, G., Gustafsson, M., & Krona, H. (2011). A theory based educational intervention targeting nurses’ attitudes and knowledge concerning cancer related pain management: A study protocol of a quasi-experimental design. BMC Health Services Research, 11(233), 1-7.
Breuer, B., Fleishman, S. B., Cruciani, R. A., & Portenoy, R. K. (2011). Medical oncologists' attitudes and practice in cancer pain management: a national survey. Journal of Clinical Oncology, 29(36), 4769-75.doi:10.1200/JCO.2011.35.0561
Buchan, H. (2006). Identifying barriers to evidence uptake. National Institute of Clinical Studies Aus-tralian, 1-67.
Burkhart, P.V. (2003). Adherence to long-term therapies:Evidence for action. Journal of
Nursing Scholarship,35(3), 207.
Cabana, M. D., Ebel, B. E., Cooper, P. L., Powe, N. R., Rubin, H. R.,& Rand, C. S. (2000). Barriers pediatricians face when using asthma practice guidelines. Arch Pediatric Ado-lescent Med, 15(7), 685-693.
Cabana, M.D & Flores, G. (2002). The role of clinical guidelines in enhancing quality and reducing ethnic disparities in pediatrics. Pediatric Respiration Reviews, 3,52-58.
Cabana, M.D & Lewis, T.C. (2001). Improving Physician Adherence to Asthma Guidelines. Journal of Clinical Outcomes Management,8(3), 35-46.
Cabana, M. D., Powe, C. S., Wu, A. W., Wilson, M. H., Abboud, P. A., & Rubin, H. R. (1999). Why don't physicians follow clinical practice guidelines? Journal of American Medical Association, 282(15), 1458-1465.
Cabana, M. D., Rand, C. S., Becher, O. J., & Rubin, H. R. (2001). Reasons for pediatrician no adherence to asthma guidelines. Arch Pediatric Adolescent Medicine, 155(9), 1057-1062.
Cabana, M.D.,Rshton, J.L., & Rush,A.J. (2002). Implementing practice guidelines for depres-sion : Applying a new framework to an old problem. General Hospital Psychiatry, 24, 35-42.
Cabana, M.D. (2010). Adherence, Not just for patients. Arch Internal Medicine, 170 (3), 277-278.
Cabana, M.D &Teo, H.K. (2010). The broader picture on guideline adherence. Journal of Parenteral Enteral Nutrition, 34,593-595.
Chou, P. L., & Lin, C.C. (2011). A pain education programme to improve patient satisfaction with cancer pain management: a randomized control trial. Journal of Clinical Nursing, 20, 1858-1869.
Chaillet, N., Dube, E., Dugas, M., Francocoeur, D., Dube, J., Gagnon, S., Poitras, L., & Dumont, A. (2007). Identifying barriers and facilitators towards implementing guide-lines to reduce Caesarean section rates in Quebec. Bulletion of the World Health Or-ganization, 85, 791-797.
Cleeland, C.S.,Gonin, R., & Hatfied, A.K. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journol of Medicine, 330, 592-596.
Conroy, M., & Shannon,W.(1995).Clinical guidelines : their implementation in general practice. British Journal General Practice 45, 371-375.
Dahan, R., Reissue, S., Borkan, J., Brown, J. B., Hermoni, D., Nadia, M., & Harris, S. (2008). Is knowledge a barrier to implementing low back pain guidelines? Assessing the knowledge of Israeli family doctors. Journal of Evaluation in Clinical Practice, 14, 785-791.
Droes, N. (2003). Role of the nurse practitioner in management patients with pain. The Inter-net Journal of Advanced Nursing Practice, 6(2), 1-8.
Dulko, D., Hertz, E., Beck, S., & Mooney, K. (2008). Implantation of cancer pain guidelines by acute care nurse practitioners using an audit and feedback strategy. Journal of the American Academy of Nurse Practitioners, 22, 45-55.
Everdinged, M. H., Rijke, J. M., Kessels, A. G., Schouten, H. C., Kleef, M., & Patijn, J. (2007). Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Annals Oncology, 18(9), 1437-1449.
Fischer, B., Nakamura, N., Urbanoski, K., Rush, B., & Rehm, J. (2012). Correlations between population levels of prescription opioid use and prescription opioid related substance use treatment admissions in the USA and Canada since 2001. Public Health, 126(9), 749-751. doi:10.1016/j.puhe.2012.04.010
Fisher, B., Lusted, A., Roerecke, M., Taylor, B., & Rehm,J. (2012). The prevalence of mental health and pain symptoms in general population samples reporting non medical use of prescription opioids: A systematic review and meta analysis. The Journal of Pain: offi-cial journal of the American Pain Society. doi:10.1016/j.jpain.2012.07.013
Fullen, B. M., Baxter, G. D., O'Donovan, B. G. G., Doody, C., Daly, L., & Hurley, D. A. (2008). Doctors' attitudes and beliefs regarding acute low back pain management: A systematic review. Pain, 136, 388-396.
Ger, L. P., Lee, M. C., Wong, C. S., Chao, S. S., Wang, J, J., & Ho, S.T. (2003). The effect of education and clinical practice on knowledge enlightenment to and attitudes toward the use of analgesics for cancer pain among physicians and medical students. ACTA Anaes-thesol SIN, 41, 105-114.
Ger, L. P., Ho, S. T., & Wang, J. J. (2000). Physicians' knowledge and attitudes toward the use of analgesics for cancer pain management: A survey of two medical centers in Tai-wan. Journal of Pain and Symptoms Management, 20(5), 335-344.
Godan, D. B., Dahl, J. L., Miaskowski, C., McCarberg, B.m Todd, K. H., Paice, J.A., Lipman, A.G, Bookbinder, M., Sanders, S. H., Turk, D. C.,& Carr, D. B.(2005). American pain society recommendation for improving the quality of acute and cancer pain manage-ment: American pain society quality of care task force. Arch Intern Med, 165(14), 1574-1580.
Green, E., Zwaal, C., Beals, C., Fitzgerald, B., Harle, I., Jones, J., Tsui, J., Volpe, J., Yoshi-moto, D., & Wiernikowski, J. (2010). Cancer related pain management : a report of evidence base recommendations to guide practice. Clinical Journal of Pain, 26(6), 449-462.
Grol, R. (2001). Successes and failures in the implementation of evidence-base for clinical practice. Medical Care, 39(2), 1146-1154.
Grol, R., & Wensing, M. (2004). What drives change? Barriers and incentives for achieving evidence-base practice. MJA, 180(15), S57-S60.
Gustafsson, M., & Borglin, G. (2013). Can a theory-based educational intervention change nurses' knowledge and attitudes concerning cancer pain management ?A qua-si-experimental design. BMC Health Services Reseach, 13(328), 1-13.
Harting, J., Rutten, G. M., Rutten, S. T., & Kremers, S. P. (2009). A qualitative application if the diffusion of innovations of guideline adherence among physical therapists. Physical Therapy, 89(3), 221-232.
Jablonski,A.,& Ersek.(2009). Nursing home staff Adherence to evidence based pain man-agement practices. Journal of Gerontological Nursing, 35(7), 28-34.
Jablonski,K., & Duke, G. Pain management in persons who are terminally ill in rural acute care: barriers and facilitators. ( 2012). Journal of hospice & Palliative nursing, 14(8), 533-540.
Kaliyaperumal, K. ( 2004). Guideline for Conducting a Knowledge, Attitude and Practice (KAP) Study. Community Ophthalmology, 4(1),7-9.
Kenefick, H., Lee, J., & Fleishman, V. (2008). Improving physician adherence to clinical practice guidelines : barrier and strategies for change. New England Healthcare Insti-tute.
Larson, E.(2004). A tool to assess barriers to adherence to hand hygiene guideline. American of Journal Infection Control, 32,48-51.
Lin, C.C. (2001). Congruity of cancer perceptions between Taiwanese patients and family-caregivers: relationship to patients' concerns about reporting pain and using analgesics. Journal of Pain and Symptoms Management , 21(1), 18-26.
Lin, C. C., Wang, P., Lai, Y. L., Lin, C. L., Tsai, S. L., & Chen, T. T. (2000). Identifying at-titudinal barriers to family management of cancer pain in palliative care in Taiwan. Pal-liative Medicine, 14(6), 463.
Lin, C. C. (2000). Barriers to the analgesic management of cancer pain: a comparison of
attitudes of Taiwanese patients and their family caregivers. Pain, 88(1), 7-14.
McCaffery, M., & Ferrell, B.R. (1997). Nurses' knowledge of pain assessment and manage
ment : How much progress have we made. Journal of Pain and Symptom Management,
14(3), 175-188.
Miaskowski, C., Dodd, M. J., West, C., Paul, S. M., Tripathy, D., Koo, P., & Schumacher.
(2001). Lack of adherences with the analgesic regimen:A significant barrier to effective
cancer pain management. Journal of Clinical Oncology, 19(23), 4275-4279.
National Comprehensive Cancer Network's treatment guidelines for adult cancer pain. Sri-sawang, P. (2013). Knowledge, attitudes and barriers of physicians, policy mak-er/regulator regarding use of opioids for cancer pain management in Thailand. Nagoya Journal Medicine,Sci,75,201-212.
Oakland, J.S.,& Tanner,S. (2007). A necw framework for managing change. Total Quality
Management,19(6),572-589.
Ogboli- Nwasor, E., Makama, J.& Yusufu, L. (2013). Evaluatation of Knowlege of can-cer pain management among medical practitioners in a low resource setting. Journol of pain Reseach , 6, 71-77.
Oldenmenger, W. H., Sillevis Smitt, P. A., Dooren, S., Stoter, G., & Rijt, C. C. (2009). A systematic review on barriers hindering adequate cancer pain management and inter-ventions to reduce them: a critical appraisal. European Journal of cancer, 45(8), 1370-1380.
Oncology Nursing Society 28th Annual Congress. (2008, May). Abstracts to be presented at
poster and podium sessions. Oncology Nursing Forum (ONCOL NURS FORUM), 30 (2
part 2): 111-67.
Pasarón, R. (2013). Nurse practitioner job satisfaction: looking for successful outcomes.
Journal of Clinical Nursing, 22 (17/18), 2593-604.
Pathman, D. E., Konrad, T. R., Freed, G. L., Freeman, V. A., & Koch, G. G. (1996). The
awareness-to-adherence model of the steps to clinical guideline compliance: the case of
pediatric vaccine recommendations. Medical Care, 34(9), 873-889.
Pang, P. (2010). Clinical practice guideline dissemination and a new approach using Haddon matrix as a conceptual framework of evidence-base implementation strategies. World Journal of Emergency Medicine, 1(1), 6-11.
Piana, R. (2013). Improving quality measurement in cancer care: policy recommendations. TheASCO Post, 4(19), 1-3.
Poitrss, S., Durand, M. J., Cote, A. M., & Tousignant, M. (2011). Use of low back pain guidelines by occupational therapist: A qualitative study of barriers and facilitators. Work, 39, 465-475. doi:10.3233/WOR-2011-1196
Quinn, D., Cooper, M., Chevalier, L., Balentine, J., Kadish, L., Walerstein, S., Weinbaum, F., Callahan, M., & Lazar, E. (2005). Can an academic health care system overcome barriers to clinical guideline implementation? Advances in patient safety, 3, 291-303.
Ring, N., Malcolm, C., Coull, A., Murphy-black, T., & Watterson, A. (2005). Nursing best practice statements : an exploration of their implementation in clinical practice. Journal ofClinical Nursing, 14, 1048-1058.
Ristevski, E., Breen, S., & Regan, M. (2011). Incorporating supportive care into routine cancer care :The benefits and challengers to clinicians’ practice. Oncology Nursing, 38(3), E204-E211.
Roenn,J.H.V.(2001).Are we the barrier? Journal of Clinical On coogy,19(23),4273-4274.
Rose, L., Smith, O., Gelinas, C., Haslam, L., Dale, C., Luke, E., Burry, L., McGillion, M., Mehta, S., & Walt-Watson, J. (2012). Critical care nurses' pain assessment and man-agement practice: a survey in Canada. American Journal of Critical Care, 21(4), 251-259. doi:10.4037/ajcc2012611
Ruegg, T. A. (2013). A nurse practitioner Led urgent care center meeting the needs of the patient with cancer. Clinical Journal of Oncology Nursing,17(4), E52-57.
Rutten, G. M., Degen, S. M., Hendriks, E. J., Braspenning, J., Harting, J., & Oostendorp, R. A.(2010). Adherence to clinical practice guidelines for low back pain in physical ther-apy:Do patients benefit? Physical Therapy, 90(8), 1111-1122.
Schoenberg, L.M. (2013). Assessing North Dakota nurse practitioners' knowledge.
Shah, L. M., Carino, T. V., Hanger, M., Barnes, L. G., & Weinestein, A. S. (2011). Barriers to clinical practice guideline adherence in the community oncology setting. Journal of Clinical Oncology, 29, 1-2.
Smith E.M.L., Bakitas, M.A., Fadul, C., & Skalla, K. (2009). Using quality improvement methodology to improve neuropathic pain screening and assessment in patients with cancer.Journal of Cancer Education, 24: 135-140.
Strohbuecker,B., Mayer, H., Evers, G.C.M.,& Sabatowski. (2005). Pain prevalence in hos-pitalized patients in a German university teaching hospital. Journal of Pain and Symp-tom Management, 29(5),498-506.
Stockler, M. R., & Wilcken, N. R. C. (2012). Why is management of cancer pain still a problem? Journal of clinical oncology, 30, 1-2. doi:10.1200/JCO.2011.39.2381
Srisawang, P., Hirosawa, T.,& Sakamato, J. (2013). Knowledge, Attitudes and Barriers of physicians, policy makers /regulators regarding use of opioids for cancer pain manage-ment in Thailand. Nagoya Journol of Medicine,75, 201-212.
Wells, N., McDowell, M.R.,Hendricks,P., Dietrich, M.S. & Murphy B. ( 2011). Cancer pain management in ambulatory care : can we link assessment and action to outcomes? Support Care Cancer, 19: 1865-1871.
Wu, C. C., & Hung, C. J. (2005 ). New Advances in Cancer Pain Management in Taiwan. Journal of Chinese Oncology Society , 25(3), 167-174.
Yun,Y.H.,Heo,D.S.,Lee,I.G.,Jeong,H.S.,Kim,H.J.,Kim,S.Y.,Kim,Y.H.,Ro,Y.J.,Yoon, S.S.,Lee,K.H.,& Huh,BY. (2003). Multicenter study of pain and its management in pa-tients with advanced cancer in Korea. Journal of Pain and Symptoms Management, 25(5),430-437.
Zech, D. F., Grond, S., Lynch, J., Hertel, D., & Lehmann, K. A. (1995).Validation of worldhealth organization guidelines for cancer pain relief: a 10 year prospective study. Pain, 63(1): 65-76.

QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文
 
1. 李卿雲、翁靜宜、林春蘭、楊廷芬(2008)‧提昇區域醫院內科護理人員對癌症疼痛評估之改善方案‧腫瘤護理雜誌,7(1),43-53。
2. 李卿雲、翁靜宜、林春蘭、楊廷芬(2008)‧提昇區域醫院內科護理人員對癌症疼痛評估之改善方案‧腫瘤護理雜誌,7(1),43-53。
3. 周幸生、黃惠美、郭素真、王靜慧、張議文(2012)‧建立成人癌症病人疼痛非藥物處置之臨床照護指引‧榮總護理,29 (2) ,145-157。
4. 周幸生、黃惠美、郭素真、王靜慧、張議文(2012)‧建立成人癌症病人疼痛非藥物處置之臨床照護指引‧榮總護理,29 (2) ,145-157。
5. 周繡玲(2011)‧臨床照護指引的發展方法‧腫瘤護理雜誌,1,15-14。
6. 周繡玲(2011)‧臨床照護指引的發展方法‧腫瘤護理雜誌,1,15-14。
7. 林昌誠(2005)‧臺灣地區癌症患者之疼痛控制‧北市醫學雜誌,2(5),423-428。
8. 林昌誠(2005)‧臺灣地區癌症患者之疼痛控制‧北市醫學雜誌,2(5),423-428。
9. 徐麗琴、林佳靜、賴裕和、陳美伶(2002)‧腫瘤護理人員對癌痛之評估及處置與相關因素探討‧新臺北護理期刊,4(2),29-38。
10. 徐麗琴、林佳靜、賴裕和、陳美伶(2002)‧腫瘤護理人員對癌痛之評估及處置與相關因素探討‧新臺北護理期刊,4(2),29-38。
11. 高以信、李楊成(2007)‧臨床醫療之癌症疼痛控制‧基層醫學,22(5),178-183。
12. 高以信、李楊成(2007)‧臨床醫療之癌症疼痛控制‧基層醫學,22(5),178-183。
13. 陳秋慧(2006)‧腫瘤進階護理之發展及現況‧腫瘤護理雜誌,5(1),37-46。
14. 陳秋慧(2006)‧腫瘤進階護理之發展及現況‧腫瘤護理雜誌,5(1),37-46。
15. 陳幼貴、胡文郁、 陳宛榆、 羅淑芬、 陳書毓 、黃翰心 (2011) ‧成人癌症疼痛臨床照護指引‧腫瘤護理雜誌, 11, 87-127。