探討護理人員與癌症病人對病人之症狀困擾、情緒困擾及靈性安適評估之一致性

Exploring of Nurses' and Cancer Patients' Agreements of Assessment in Patients' Symptom Distress, Emotional Distress, and Spiritual Well-being

10.6530/YYN.201903_13(1).0004

曲幗敏(Kuo-Min Chu)；蔡玉鳳(Yu-Feng Tsai)；蘇僅涵(Chin-Han Su)；林聿品(Yu-Ping Lin)；黃金瑩(Chin-Ying Huang)；陳美碧(Mei-Bih Chen)

癌症病人 ； 護理人員 ； 症狀困擾 ； 情緒困擾 ； 靈性安適 ； 評估一致性 ； Cancer patient ； nurse ； symptom distress ； emotional distress ； spiritual well-being ； assessment agreement

源遠護理

13卷1期（2019 / 03 / 01）

29 - 40

繁體中文

背景：癌症病人於治療過程會經歷副作用帶來的症狀困擾，良好的症狀管理需要正確的評估。臨床發現護理人員與癌症病人對病人之症狀評估不一致，不論高估或低估，都可能導致不適當的介入措施，影響症狀緩解成效及生活品質。目的：探討護理人員與癌症病人對病人之症狀困擾、情緒困擾及靈性安適評估之一致性。方法：本研究為橫斷式研究設計，採方便取樣，共有104位癌症病人與護理人員參與，以結構性問卷為研究工具，包含：護理人員及病人基本屬性、台灣版安德森症狀量表、醫院焦慮憂鬱量表及功能評估之靈性安適量表。結果：護理人員能辨識癌症病人主要之症狀困擾。一致性方面，症狀困擾（ICC=.35, p=.00）與靈性安適（ICC=.30, p=.00）評估之一致性偏低，情緒困擾（ICC=.44, p=.00）評估之一致性則屬於中等。護理人員對於病人之症狀困擾評估（d=-0.48, p=.00）與靈性安適評估（d=-0.27, p=.00）之平均得分低於病人。有46.2%及40.4%的護理人員傾向於低估病人症狀困擾與靈性安適。結論與實務運用：癌症病人的症狀評估需包含身、心、靈，護理人員於每日照顧過程中須落實相關評估，唯有正確的評估才能有效緩解病人的症狀，提升病人照護品質。

Background: Most patients with cancer experience treatment-related side effects. Management of symptoms requires adequate symptom assessment. Clinical observation showed that there were discrepancies on symptom assessment between nurses and their patients. Nurses over or under estimation of patients' symptoms may lead to inappropriate medical interventions, symptom relief efforts and the quality of care. Purpose: To explore consistency in symptom distress, emotional distress, and spiritual well-being assessments between nurses and cancer patients. Methods: This study was a cross-sectional study using convenience sampling of 104 cancer patient-nurse dyads. The patient and nurse in each pair independently completed a structured questionnaire, including patients and nurses demographics, the M. D. Anderson symptom inventory, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Chronic Illness Therapy- Spiritual Well- Being. Results: The nurses were able to identify major symptoms of cancer patients. However, patients and nurses showed poor agreement in the symptom distress (ICC = .35, p = .00), spiritual well- being (ICC = .30, p = .00), and moderate agreement in emotional distress (ICC = .44, p ＜ .00). The nurses mean scores of symptom distress (d = -.48, p = .00) and spiritual well-being (d = -.27, p = .00) were lower than those of the cancer patients. Nurses underestimated their matched patients' symptom distress in 46.2%, and spiritual wellbeing in 40.4%. Conclusion: Assessing symptom distress in cancer patients should include physical, emotional, and spiritual. The nurses should perform relevant assessment in their daily care process. Appropriate assessment can significantly improve symptom relief and quality of patient care.

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