加護病房護理人員生命態度與死亡因應自我效能之相關性探討

The Relationship Between Life Attitude and Death Coping Self-Efficacy in Intensive Care Nurses

10.6224/JN.202010_67(5).06

連如玉(Ru-Yu LIEN)；盧淑芬(Shu-Fen LU)；王媛(Yuan WANG)；金淑儀(Shu-I CHIN)；熊道芬(Tao-Fen SHIUNG)

加護病房 ； 護理人員 ； 死亡因應自我效能 ； 生命態度 ； intensive care unit ； nurses ； death coping self-efficacy ； life attitude

護理雜誌

67卷5期（2020 / 10 / 01）

33 - 43

繁體中文

背景：護理人員是重症照護的核心人物，瞭解護理人員生命態度及死亡因應自我效能至關重要，是未來執行相關教育訓練之參考依據。目的：了解加護單位護理人員生命態度與死亡因應自我效能之概況與其之間的相關性，並探討生命態度對死亡因應自我效能之預測。方法：採橫斷式設計，研究對象為北部某醫學中心成人加護病房216位護理人員，研究工具為死亡因應自我效能量表及生命態度量表；採皮爾森積差相關、t-檢定、單因子變異數分析及多元迴歸等方式進行資料分析。結果：結果顯示：（1）相關得分為：死亡因應自我效能為112.0±14.3分，次量表以臨終關懷最高（51.1±6.3）；生命態度為128.9±13.8分，次量表以生命自主最高（24.0±3.2）。（2）有照顧末期撤除維生醫療經驗者死亡因應自我效能較佳（t=1.94, p=.05）；研究所以上較大學（含專科）教育程度的生命態度較佳（t=-2.11, p=.04）。（3）年齡及加護年資與死亡因應自我效能之次量表哀傷因應呈顯著正相關（r=.315; r=.241）；生命態度次量表中理想、生命自主、愛與關懷與死亡因應自我效能達顯著正相關（r=.138-.482）。（4）年齡、理想、生命自主及愛與關懷為死亡因應自我效能之共同預測因子，解釋30.1%變異量（F=12.78, p＜.001）。結論：加護病房護理人員之生命態度影響其死亡因應自我效能；未來執行加護訓練及在職教育時建議強化生命態度和臨終關懷相關訓練，促進正向生命態度，進而增進死亡因應自我效能，提升重症臨床照護品質。

Background: Critical care nurses must often care for patients who are dying and their families. Thus, understanding the self-efficacy and life attitudes of nursing staff in the ICU in response to death is important to the development and provision of relevant education and training. Purpose: This study was designed to explore the self-efficacy of ICU nurses in response to death and related predictive factors. Methods: This was a cross-sectional research study. The subjects were 216 nurses in the adult ICU of a medical center in northern Taiwan. The research tools used included the death coping self-efficacy scale and the life attitude scale. Data were analyzed using Pearson's correlation, t-test, one-way ANOVA, and multiple regression. Result: The results showed: 1. In terms of death coping self-efficacy, the mean score was 112.0 ± 14.3, with the highest scoring subscale, hospice care, earning a mean score of 51.1 ± 6.3. In terms of life attitude, the mean score was 128.9 ± 13.8, with the highest scoring subscale, life autonomy, earning a mean score of 24.0 ± 3.2. 2. Nurses with experiences of withdrawal of life support had better coping efficacy (t = 1.94, p = .05) and those with a graduate degree or above earned a better average life attitude score than those educated to the university / junior college level. 3. Age and ICU seniority were found to correlate positively with grief-related coping skills (r = .241- .315), with the life-attitude subscales of aspiring, life-autonomy, love, and caring showing positive correlations with death coping self-efficacy (r = .138- .482). 4. The predictors found in this study for death coping self-efficacy were age, aspiring, life-autonomy, love, and caring, with a total explained variance of 30.1% (F = 12.78, p ＜ .001). Conclusion: The results of this study indicate that education level and having hospice care experience are both significant predictors of life attitude in ICU nurses, which is a factor that is known to affect self-efficacy in response to death. Life attitude and hospice care training programs for ICU nurses should be promoted to foster positive life attitudes and thereby enhance self-efficacy in response to death to improve the quality of intensive clinical care.

1. Huang, C.-C.,Chen, J.-Y.,Chiang, H.-H.(2016).The transformation process in nurses caring for dying patients.The Journal of Nursing Research,24(2),109-117.
   連結：
2. 陳怡潓, Y.-H.,曾煥棠, H.-T.(2017)。加護病房護理人員死亡處理能力之探討。健康科技期刊，4(1)，21-43。
   連結：
3. 楊惠玲, H.-L.,陳蘊珩, Y.-H.,林純如, C.-R.,林小玲, S.-L.,胡麗霞, L.-S.(2016)。護理人員照顧末期病人的情緒困擾與死亡因應自我效能之關聯－以北部某醫學中心為例。安寧療護雜誌，21(1)，16-29。
   連結：
4. 安寧緩和醫療條例（2013，1月9日）．總統華總一義字第10200000811號令修正。https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020066 [Hospice Palliative Care Act, President Order Hua-Zong-Yi-Yi-Tzu No. 10200000811 amended. (2013, January 9). https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020066]
5. 病人自主權利法（2019，6月12日）．總統華總一義字第10800059281號令修正。https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020189 [Patient Right to Autonomy Act, President Order Hua-Zong-Yi-Yi-Tzu No. 10800059281 amended. (2019, June 12). https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0020189]
6. Ackerman, C. E. (2020, January 9). What is self-efficacy theory in psychology? PositivePsychology.com. https://positivepsychology.com/self-efficacy/
7. Bandura, A.(1986).Social foundation of thoughts and action.Prentice Hill.
8. Barnett, M. D.,Moore, J. M.,Garza, C. J.(2019).Meaning in life and self-esteem help hospice nurses withstand prolonged exposure to death.Journal of Nursing Management,27(4),775-780.
9. Barnett, M. D.,Reed, C. M.,Adams, C. M.(2020).Death attitudes, palliative care self-efficacy, and attitudes toward care of the dying among hospice nurses.Journal of Clinical Psychology in Medical Settings
10. Baumeister, R. F.(Ed.)(1999).The self in social psychology.Psychology Press.
11. Bhatt, M.,Lizano, D.,Carlese, A.,Kvetan, V.,Gershengorn, H. B.(2017).Severe burnout is common among critical care physician assistants.Critical Care Medicine,45(11),1900-1906.
12. Chang, W. P.(2018).How social support affects the ability of clinical nursing personnel to cope with death.Applied Nursing Research,44,25-32.
13. De Vaus, J.,Hornsey, M. J.,Kuppens, P.,Bastian, B.(2018).Exploring the east-west divide in prevalence of affective disorder: A case for cultural differences in coping with negative emotion.Personality and Social Psychology Review,22(3),285-304.
14. Fida, R.,Laschinger, H. K. S.,Leiter, M. P.(2018).The protective role of self-efficacy against workplace incivility and burnout in nursing: A time-lagged study.Health Care Management Review,43(1),21-29.
15. Fridh, I.(2014).Caring for the dying patient in the ICU - The past, the present and the future.Intensive and Critical Care Nursing,30(6),306-311.
16. Giske, T.,Cone, P. H.(2012).Opening up to learning spiritual care of patients: A grounded theory study of nursing students.Journal of Clinical Nursing,21(13-14),2006-2015.
17. Hoffman, A. J.(2013).Enhancing self-efficacy for optimized patient outcomes through the theory of symptom self-management.Cancer Nursing,36(1),E16-E26.
18. Hotchkiss, J. T.(2018).Mindful self-care and secondary traumatic stress mediate a relationship between compassion satisfaction and burnout risk among hospice care professionals.American Journal of Hospice and Palliative Medicine,35(8),1099-1108.
19. Kapoor, S.,Morgan, C. K.,Siddique, M. A.,Guntupalli, K. K.(2018)."Sacred pause" in the ICU: Evaluation of a ritual and intervention to lower distress and burnout.American Journal of Hospice and Palliative Care Medicine,35(10),1337-1341.
20. LaMorte, W. W. (2019, September 9). The social cognitive theory. http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories5.html
21. Mast, M.,Gillum, D.(2018).Case study of nurses’ experiences related to the deaths of their patients.The Health Care Manager,37(4),325-332.
22. Montross-Thomas, L. P.,Scheiber, C.,Meier, E. A.,Irwin, S. A.(2016).Personally meaningful rituals: A way to increase compassion and decrease burnout among hospice staff and volunteers.Journal of Palliative Medicine,19(10),1043-1050.
23. Quenot, J. P.,Rigaud, J. P.,Prin, S.,Barbar, S.,Pavon, A.,Hamet, M.,Jacquiot, N.,Blettery, B.,Hervé, C.,Charles, P. E.,Moutel, G.(2012).Suffering among carers working in critical care can be reduced by an intensive communication strategy on end-of-life practices.Intensive Care Medicine,38(1),55-61.
24. Soudagar, S.,Rambod, M.,Beheshtipour, N.(2015).Factors associated with nurses’ self-efficacy in clinical setting in Iran, 2013.Iran Journal of Nursing and Midwifery Research,20(2),226-231.
25. Stokes, H.,Vanderspank-Wright, B.,Fothergill Bourbonnais, F.,Wright, D. K.(2019).Meaningful experiences and endof-life care in the intensive care unit: A qualitative study.Intensive and Critical Care Nursing,53,1-7.
26. Walker, W.,Deacon, K.(2016).Nurses’ experiences of caring for the suddenly bereaved in adult acute and critical care settings, and the provision of person-centred care: A qualitative study.Intensive and Critical Care Nursing,33,39-47.
27. Wilson, J.,Kirshbaum, M.(2011).Effects of patient death on nursing staff: A literature review.British Journal of Nursing,20(9),559-563.
28. Wong, P. (2017, August 16). Death acceptance and the meaning-centered approach to end-of-life care. http://www.drpaulwong.com/death-acceptance-meaning-centeredapproach-end-life-care/
29. Zheng, R.,Guo, Q.,Dong, F.,Gao, L.(2020).Death self-efficacy, attitudes toward death and burnout among oncology nurses: A multicenter cross-sectional study.Cancer Nursing
30. 張利中, L.-J.,鄭美莉, M.-L.,王萱萁, H.-C.(2006)。台灣地區安寧護理人員死亡因應自我效能量表之研究。安寧療護雜誌，11(1)，1-13。
31. 郭美璋, M.-C.,林昭光, C.-K.,洪栩隆, H.-L.(2011)。臨床護理人員之死亡態度。健康促進暨衛生教育雜誌，31，17-38。
32. 鄭企峰, C.-F.,林承霈, C.-P.,蕭勝煌, S.-H.(2018)。提升死亡識能以提供高品質晚期癌症照護。北市醫學雜誌，15，54-60。
33. 謝曼盈, M.-Y.,潘靖瑛, C.-Y.(2015)。簡短版生命態度量表之效度研究。慈濟大學教育研究學刊，12，189-209。

1. 連如玉,金淑儀,王曉君(2022)。一位低溫治療無效病人撤除維生醫療之加護經驗。領導護理，23(3)，134-149。
2. (2024)。長照機構照顧服務員生命態度、死亡恐懼與臨終照顧能力之研究。護理雜誌，71(5)，58-69。