Effects of the Advanced Innovative Internet-Based Communication Education Program on Promoting Communication Between Nurses and Patients With Dementia

愛思溝通教育方案對增進護理人員與失智患者之溝通成效探討

10.1097/jnr.0000000000000109

趙慧珍(Hui-Chen Chao)；Merrie Kaas；蘇英華(Ying-Hwa Su)；林梅鳳(Mei-Feng Lin)；黃美智(Mei-Chih Huang)；王靜枝(Jing-Jy Wang)

溝通教育計畫 ； 失智症 ； 護理人員 ； 長期照護機構 ； communication education program ； dementia ； nurses ； long-term care facilities

The Journal of Nursing Research

24卷2期（2016 / 06 / 01）

163 - 172

英文

背景　與失智症患者有效的溝通可確認患者需求及降低護理人員與患者間因溝通不良而產生的衝突，進而提升照護品質。目的　本研究之目的為驗證一項以網路為平台之進階革新失智溝通教育計畫（中文簡稱直接取英文縮寫發音，命名為愛思計畫）對護理人員在面對失智個案之溝通知識、溝通態度、評估患者溝通能力及溝通表現的促進成效。此外，亦間接驗證受照顧的失智症患者的記憶與行為問題與憂鬱狀態之促進成效。方法　本研究採單組、重覆測量之類實驗法，以方便取樣招募南台灣長期照護機構護理人員參與本研究。資料分析則以廣益估計方程式（GEE）分別於參與愛思溝通教育計畫前、參與後第4週及第16週進行成效檢測；共105位護理人員參與並完成二次追蹤測量。結果　護理人員在參與愛思溝通教育計畫後第4週及第16週之溝通知識、評估患者溝通能力及溝通表現與前測比較達統計上顯著差異（p ＜ .01）；但在溝通態度部分則未達統計上顯著差異（p = .40）。在患者成效方面，護理人員在參與愛思溝通教育計畫後其所照顧的失智症患者之記憶與行為問題和憂鬱狀態成效則於參與後第16週達統計上顯著差異（p = .05）。結論　愛思溝通教育計畫可有效改善護理人員在面對失智個案之溝通知識、評估患者溝通能力及溝通表現，更進一步減緩個案記憶與行為問題與和憂鬱狀態。未來愛思溝通計畫可做為失智症溝通教育計畫指標及繼續教育之指引。

Background: Effective communication between nurses and patients with dementia promotes the quality of patient care by improving the identification of patient needs and by reducing the miscommunication-related frustration of patients and nurses. Purpose: This study evaluates the effects of an advanced innovative Internet-based communication education (AIICE) program on nurses' communication knowledge, attitudes, frequency of assessing patient communication capacity, and communication performance in the context of care for patientswith dementia. In addition, this study attempts to evaluate the indirect effects of this program on outcomes for patients with dementia, includingmemory and behavior-related problems and depressive symptoms. Methods: A quasi-experimental research design with a one-group repeatedmeasure was conducted. Convenience sampling was used to recruit nurses from long-term care facilities in southern Taiwan. Datawere analyzed using general estimating equations to compare changes over time across three points: baseline, fourthweek posttest, and 16th-week posttest. One hundred five nurses completed the AIICE program and the posttest surveys. Results: The findings indicate that nurses' communication knowledge, frequency in assessing patients’ communication capacity, and communication performance had improved significantly over the baseline by either the 4th- or 16th-week posttest (p G .01). However, communication attitude showed no significant improvement in the posttest survey (p = .40). Furthermore, the findings indicate that the memory and behavior-related problems and the depressive symptoms of patients had decreased significantly by the 16th-week posttest (p = .05). Conclusions/Implications for Practice: This study showed that the AIICE program improves nurses' communication knowledge, frequency to assess patients' communication capacity, and communication performance and alleviates the memory and behavior-related problems and depressive symptoms of patients. The continuous communication training of nurses using the AIICE program is thus recommended.

1. Lin, J. N.,Wang, J. J.(2008).Psychometric evaluation of the Chinese version of the Cornell Scale for Depression in Dementia.The Journal of Nursing Research,16(3),202-210.
   連結：
2. Taiwan Alzheimer's Disease Association. (2015). Estimation of population in dementia between 2013~2060 in Taiwan. Retrieved from http://www.tada2002.org.tw/tada_know_02.html#01
3. Becker University. (2012). Bachelor of science in nursing (RN to BSN) curriculum. Retrieved from https://www.cedarville.edu/Academics/Nursing/Undergraduate/Majors/Nursing.aspx
4. Ajjawi, R.,Higgs, J.(2012).Core components of communication of clinical reasoning: A qualitative study with experienced Australian physiotherapists.Advanced in Health Science Education,17(1),107-119.
5. Alexander,G.K.,Uz, S. W.,Hinton, I.,Williams, I.,Jones, R.(2008).Culture brokerage strategies in diabetes education.Public Health Nursing,25(5),461-470.
6. Alexopoulos,G. S.,Abrams, R. C.,Young, R. C.,Shamoian, C. A.(1988).Cornell Scale for Depression in Dementia.Biological Psychiatry,23(3),271-284.
7. Alzheimer's Association(2013).2013 Alzheimer's disease facts and figures.Alzheimer's & Dementia,9(1),1-71.
8. Broughton,M.,Smith, E. R.,Baker, R.,Angwin, A. J.,Pachana, N. A.,Copland, D. A.,Chenery, H. J.(2011).Evaluation of a caregiver education program to supportmemory andcommunication in dementia: A controlled pretestYposttest study with nursing home staff.International Journal of Nursing Studies,48(11),1436-1444.
9. Burgio, L. D.,Stevens, A.,Burgio, K. L.,Roth, D. L.,Paul, P.,Gerstle, J.(2002).Teaching and maintaining behavior management skills in the nursing home.The Gerontologist,42(4),487-496.
10. Byerly, M. J.,Nakonezny, P. A.,Bettcher, B. M.,Carmody, T.,Fisher, R.,Rush, A. J.(2006).Sexual dysfunction associated with second-generation antipsychotics in outpatients with schizophrenia or schizoaffective disorder: An empirical evaluation of olanzapine, risperidone, and quetiapine.Schizophrenia Research,86(1-3),244-250.
11. Chen, T. F.,Chiu,M. J.,Tang, L. Y.,Chiu, Y. H.,Chang, S. F.,Su, C. L.,Chen, R.C.(2007).Institution type-dependent high prevalence of dementia in long-term care units.Neuroepidemiology,28(3),142-149.
12. Cohen-Mansfield, J.,Golander, H.(2011).The measurement of psychosis in dementia: A comparison of assessment tools.Alzheimer Disease and Associated Disorder,25(2),101-108.
13. Craig, R. L.(Ed.)(1996).The ASTD training and development handbook.NewYork, NY:McGraw-Hill.
14. Dingwall, L.,McLafferty, E.(2006).Do nurses promote urinary continence in hospitalized older people? An exploratory study.Journal of Clinical Nursing,15(10),1276-1286.
15. Done,D. J.,Thomas, J. A.(2001).Training in communication skills for informal carers of people suffering from dementia: A cluster randomized clinical trial comparing a therapist led workshop and a booklet.International Journal of Geriatric Psychiatry,16(8),816-821.
16. Frazier-Rios, D.,Zembrzuski, C.(2005).Communication difficulties: Assessment and interventions.Dermatology Nursing,17(4),319-320.
17. Fuh, J. L.,Liu, C. Y.,Wang, S. J.,Wang, H. C.,Liu, H. C.(1999).Revisedmemory and behavior problems checklist in Taiwanese patients withAlzheimer's disease.International Psychogeriatrics,11(2),181-189.
18. Knowles, M.(1984).Andragogy in action: Apply modern principle of adult education.San Francisco, CA:Jossey-Bass.
19. Kristiansen, L.,Hellzén, O.,Asplund, K.(2006).Swedish assistant nurses' experiences of job satisfaction when caring for persons suffering fromdementia and behavioral disturbances. An interview study.International Journal of Qualitative Studies on Health & Well-Being,1(4),245-256.
20. Kurlowicz, L. H.,Evans, L. K.,Strumpf, N. E.,Maislin, G.(2002).A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursinghomepopulation.American Journal of Geriatric Psychiatry,10(5),600-608.
21. McCallion, P.,Toseland, R. W.,Lacey, D.,Banks, S.(1999).Educating nursing assistants to communicate more effectively with nursing homeresidentswith dementia.The Gerontologist,39(5),546-558.
22. Molinuevo, B.,Torrubia, R.(2011).Validation of the Catalan version of the communication skills attitude Scale (CSAS) in a cohort of south European medical and nursing students.Education for Health,24(1),499.
23. Moore, C. D.(2008).Enhancing health care communication skills: Preliminary evaluation of a curriculum for family caregivers.Home Health Care Service Quarterly,27(1),21-35.
24. Neil, W.,Bowie, P.(2008).Carer burden in dementia-Assessing the impact of behavioural and psychological symptoms via self-report questionnaire.International Journal of Geriatric Psychiatry,23(1),60-64.
25. Novotny, J.(2000).Distance education in nursing.New York, NY:Springer.
26. Petty, R. E.,Tormala, Z. L.,Briñol, P.,Jarvis, W. B. G.(2006).Implicit ambivalence from attitude change: An exploration of the PAST model.Journal of Personality and Social Psychology,90(1),21-41.
27. Rees, C.,Sheard, C.,Davies, S.(2002).The development of a scale tomeasuremedical students' attitudes towards communication skills learning: The Communication Skills Attitude Scale (CSAS).Medical Education,36(2),141-147.
28. Ripich, D. N.,Wykle, M.,Niles, S.(1995).Alzheimer's disease caregivers: The focused program.Acommunication skills training program helps nursing assistants to give better care to patients with Alzheimer's disease.Geriatric Nursing,16(1),15-19.
29. Shapira, N.,Barak, A.,Gal, I.(2007).Promoting older adults' well-being through Internet training and use.Aging and Mental Health,11(5),477-484.
30. Small, J. A.,Gutman, G.,Makela, S.,Hillhouse, B.(2003).Effectiveness of communication strategies used by caregivers of persons persons with Alzheimer's disease during activities of daily living.Journal of Speech, Language and Hearing Research,46(2),353-367.
31. Tavakol, M.,Torabi, S.,Lyne, O. D.,Zeinaloo, A. A.(2005).A quantitative survey of intern's knowledge of communication skills: An Iranian exploration.BMC Medical Education,5(1),6.
32. Teri, L.,Truax, P.,Logsdon, R.,Uomoto, J.,Zarit, S.,Vitaliano, P. P.(1992).Assessment of behavioral problems in dementia: The revisedmemory and behavior problems checklist.Psychological Aging,7(4),622-631.
33. Thompson, E. W.(2009).USA.,Arizona States University.
34. Tseng, G. I.(2007).Kaohsiung, Taiwan, ROC,National Sun Yat-sen University.
35. Waddington, C.,Hill, C.(2006).Protection of patient safety and improvement of outcomes through pre-bisphonate dental evaluations using multidisciplinary collaboration: Prevention of osteonecrosis of the jaw.Oncology Nursing Forum,33(2),396.
36. Wang, J. J.,Hsieh, P. F.,Wang, C. J.(2013).Long-term care nurses' communication difficulties with people living with dementia in Taiwan.Asian Nursing Research,7(3),99-103.
37. Weitzel,T.,Robinson, S.,Barnes,M. R.,Berry, T. A.,Holmes, J.M.,Mercer, S.,Kirkbirde, G. L.(2011).The special needs of the hospitalized patient with dementia. Med-Surg Nursing.Med-Surg Nursing,20(1),13-18.
38. Williams, K. N.,Herman, R.,Gajewski, B.,Wilson, K.(2009).Eledrspeak communication: Impact on dementia care.American Journal of Alzheimer's Disease and Other Disease,24(1),11-20.

1. 賴錦緣、陳勝美(2018)。運用網路同儕互評促進護理溝通技巧。數位學習科技期刊，10(2)，59-85。
2. 蘇信鳳,涂世俊,林孟薇,李浩銘,李文禮,宋惠娟,王秀美(2022)。失智照護行動學習及支持計畫運用於居家照顧服務員可行性之探討。長期照護雜誌，24(3)，249-265。
3. 蘇信鳳、林孟薇、宋惠娟、王秀美(2018)。居家照顧服務員對失智症照顧知識、態度與自覺照顧能力之探討。榮總護理，35(2)，152-162。