陳月枝臺灣大學：護理學研究所李慧芬Lee, Hui-fenHui-fenLee2007-11-272018-07-072007-11-272018-07-072004http://ntur.lib.ntu.edu.tw//handle/246246/55751本研究旨在了解並探討台北地區國小校護對照護糖尿病學童之知識、態度、行為傾向及其相關因素。採橫斷式調查法，以自擬結構式問卷為研究工具，運用郵寄問卷方式進行資料收集，選擇台北地區360所公私立國民小學校護共387人(包括27所國小設置校護2名)為研究對象。共回收有效問卷218份，回收率56.33%。所收集之資料以SPSS11.0 for Windows統計套裝軟體依據研究假設進行描述性及推論性統計分析。重要結果如下： 一、兩百一十八位校護服務於208個學校，其學生與校護之人數比值平均為1298。研究對象中，214位沒有糖尿病，有4位不知道自己是否有糖尿病。58.72%有患糖尿病的親友，51.0%有直接照護糖尿病親友或病人的經驗，38.99%在擔任校護期間曾接觸過糖尿病學童。 二、台北地區校護關於糖尿病之主要知識來源依次為「護理養成教育」、「在職教育或訓練」、「書籍」及「醫護專業期刊」。 三、知識量表平均得分為14.18(答對率70.9%)。平均答對率較好的項目為「日常生活指導」，較差的為「病因與流行病學」、「急性併發症及其處理」。關於高血糖與酮酸中毒症狀的區別，只有不到一成的校護答對。 四、態度量表平均得分為75.77(得分可能範圍20-100分)。整體而言，研究對象對照護糖尿病學童之態度趨於正向。且對提供糖尿病童及教師相關的知識有很高的認同。 五、行為傾向量表平均得分為56.35(得分百分比為70.44%)。平均得分較高的題目為「能主動蒐集並閱讀糖尿病新知，以增進照護的能力」、「當發現有疑似糖尿病學童時，能做適當轉介並追蹤」、以及「教導糖尿病學童有關合併症的預防之知識」。平均得分較低的題目為「準備並管理糖尿病學童所需的緊急用藥及器材」、「召開糖尿病學童個案討論會」、以及「與校外醫療照顧人員溝通」。 六、與知識量表得分達統計上顯著差異的變項為「近五年內是否曾參加糖尿病相關之研習」，且「最高學歷」與知識量表得分成正相關。 七、與態度量表得分達統計上顯著差異的變項皆為「學校班級數」、「學生人數和校護人數比值」、「最高學歷」與「近五年內是否曾參加糖尿病相關之研習」。其中「學校班級數」、「學生校護人數比值」與量表得分成負相關，而「最高學歷」與量表得分成正相關。 八、與行為傾向量表得分達統計上顯著差異的變項皆為「學校班級數」、「學生人數和校護人數比值」、「最高學歷」、「年齡」與「近五年內是否曾參加糖尿病相關之研習」，其中「學校班級數」、「學生校護人數比值」與量表得分成負相關，而「最高學歷」與量表得分成正相關。 九、台北縣、市國民小學校護對於照護糖尿病學童之行為傾向與其對知識與態度間均成正相關。至於糖尿病之知識與態度間，則無顯著的相關。 根據研究結果，本研究建議： 一、校護：主動爭取進修機會，積極參與學校衛生護理專業團體。 二、學校衛生護理專業團體：發展校園糖尿病管理之標準程序及管理工具，定期舉辦個案管理及糖尿病照護研習。 三、教育及衛生當局：推動及建立學校護理專科證照制度，建構學校、醫療機構、社區的糖尿病照護資源網路。The purpose of this study was to explore the level of knowledge, attitude, behavior intention and their related factors concerning taking care of students with diabetes by elementary school nurses in Taipei City and Taipei County. A cross-sectional study design was conducted via structured questionnaire collected by mail. The elementary school nurses were from 360 public and private primary schools in Taipei. Total subjects were 387. Two hundred and eighteen valid questionnaires were returned (56.33%) and used for data analysis. Data were analyzed by descriptive and inferential statistics through the SPSS 11.0 for Window Software. Significant results were summarized as followed： 1. Among 208 schools that 218 school health nurses came from, the students and nurses were in the average ratio of 1298 to 1. Among 218 school health nurses, 214 nurses have no diabetes and 4 nurses don’t know if they had diabetes or not. 58.72% of study subjects have diabetic family members or friends. 51.0% of them had took care their family members or patients with diabetes directly. 38.99% of them had or had ever had diabetic students when they served in school. 2. The main resource that study subjects got diabetes knowledge was “ nursing education in school ”, ” continuing education or training on-the-job ”, ” books ”, “medical or nursing journals ”. 3. The mean diabetes knowledge score was 14.18 out of a possible 20 (the percentage of correct answer was 70.9). The study subjects scored the highest on “direction for diabetic patients’ every day life”. The lower score that subjects attained was in two categories of “etiology and prevalence of diabetes” and “the acute complication and treatment”. More than 90% of study subjects confused hyperglycemia and ketoacidosis. 4. The mean diabetes attitude score was 75.77 out of a possible 100. On the whole, the attitude tendency of subjects toward the management and caring for school children with diabetes was positive. And the school nurses were willing to provide health consultation and guidance for the diabetic students and their teachers. 5. The mean score of behavior intention scale was 56.35 out of a possible 80. The study subjects scored the higher on ”acquiring and maintaining the knowledge and skills necessary to provide comprehensive care”, “referring and following up properly when finding a suspect case of diabetes” and ”providing health education about complication of diabetes for the diabetic students”. The lower score that subjects attained was in three categories of ”managing the medicine and equipment for diabetes emergencies”, “conducting a case conference of diabetic student” and “communicating with staff of the hospital or institution”. 6. The variables that impacted on the levels of knowledge were “whether or no subjects had attended diabetes seminars in 5 years”. “The highest level of nursing education” and the scores of diabetes knowledge were statistically significantly positive correlated. 7.The variables that impacted on the attitude were ”number of classes in the school”, “ratio of students and nurses”, “the highest level of nursing education” and “whether or no subjects had attended diabetes seminars in 5 years”. The first two were statistically significantly negative correlated with the scores of diabetes attitude, “the highest level of nursing education” was statistically significantly positive correlated with the scores of diabetes attitude. 8.The variables that impacted on the behavior intention were ”number of classes in the school”, “ratio of students and nurses”, “the highest level of nursing education”, “age” and “whether or no subjects had attended diabetes seminars in 5 years”. The first two were statistically significantly negative correlated with the scores of behavior intention scale, “the highest level of nursing education” was statistically significantly positive correlated with the scores of behavior intention scale. 9. There was a significant positive correlation between behavior intention and knowledge. There was a significant positive correlation between behavior intention and attitude. There was no significant correlation between knowledge and attitude. According to the results of this study, we propose the followings: 1. For school health nurses：expanding opportunities in continuing education actively, taking part in the professional groups of school nursing. 2. For professional groups of school nursing：developing the practicing standards and tools for school diabetes management, directing periodical diabetes seminars for school nurses. 3. For the Administrations of Education and Public health：making a professional license system for specialist nurse of school health, constructing a network of diabetes care resources among schools, medical institution and community.目錄 第壹章 緒論 第一節 研究動機 1 第二節 研究目的 3 第三節 研究問題 4 第四節 名詞界定 5 第二章 文獻查證 第一節 糖尿病概述 7 第二節 學校護士與糖尿病學童之照護 19 第三節 學校糖尿病管理 23 第四節 有關知識、態度與行為傾向的研究 27 第三章 研究方法 第一節 研究架構 31 第二節 研究假設 32 第三節 研究設計 32 第四節 研究對象 33 第五節 研究工具 33 第六節 研究實施步驟 38 第七節 倫理考量 40 第八節 資料處理與分析 41 第四章 研究結果 第一節 研究對象之社會人口學特徵 43 第二節 與糖尿病有關的經驗 46 第三節 糖尿病知識現況 50 第四節 照護糖尿病學童之態度現況 52 第五節 照護糖尿病學童之行為傾向現況 55 第六節 人口學變項與照護糖尿病學童之知識、態度和行為傾向的關係 58 第七節 與糖尿病有關的經驗和照護糖尿病學童之知識、態度和行為傾 向的關係 65 第八節 照護糖尿病學童之知識、態度和行為傾向之間的關聯性 69 第九節 有關校護執行校園糖尿病照護管理的建議事項 72 第十節 校護執行校園糖尿病照護的經驗 76 第五章 討論 第一節 校護的工作負荷 77 第二節 校護的專業成長 79 第三節 校護的角色與弁?85 第四節 校園慢性病照護管理 87 第六章 結論與建議 第一節 結論 90 第二節 應用與建議 93 第三節 研究限制 96 參考資料 中文部份 97 英文部分 101 附錄 附錄一 專家效度問卷審核專家名單 105 附錄二 專家效度評分說明 106 附錄三 專家效度評分表 107 附錄四 預試問卷 116 附錄五 研究知會及同意書 122 附錄六 正式問卷 123 附錄七 糖尿病學生個案管理計畫及照護工具 129 附錄八 台北地區國小校護校園糖尿病照護經驗分享 138 圖表目錄 圖3-1 概念架構圖 31 表2-1 1985年世界衛生組織糖尿病分類法 8 表2-2 1997年美國糖尿病學會分類法 8 表2-3 第1型與第2型糖尿病特性之比較 9 表3-1 專家效度之平均得分及專家一致性 36 表3-2 各量表的信度測試結果 37 表3-3 統計資料分析 41 表4-1 社會人口學特徵-任職學校規模 43 表4-2 社會人口學特徵-基本資料 44 表4-3 社會人口學特徵-專業背景 45 表4-4 研究對象及其親友罹患糖尿病的情形 46 表4-5 研究對象接觸糖尿病學童之情形 47 表4-6 208所學校之糖尿病學童就讀年級之分布情形 47 表4-7 糖尿病照護相關知識來源 49 表4-8 知識量表答題情形 50 表4-9 知識量表得分情形 51 表4-10 態度量表答題情形 …52 表4-11 態度量表得分情形 54 表4-12 行為傾向量表答題情形 55 表4-13 行為傾向量表得分情形 56 表4-14 校護在執行校園糖尿病管理所遇到的困難 57 表4-15 知識、態度、行為傾向量表之偏態、峰度及變異係數 58 表4-16 校護最高學歷與知識、態度、行為傾向之斯皮爾曼等級相關分析 59 表4-17 人口學變項與知識量表得分之檢定 59 表4-18 人口學變項與態度量表得分之檢定 61 表4-19 「學校班級數、學生人數、學生和校護人數比值」與「態度量 表得分、行為傾向量表得分」的斯皮爾曼等級相關 63 表4-20 人口學變項與行為傾向量表得分之檢定 63 表4-21 與糖尿病有關的經驗和知識量表得分之檢定 65 表4-22 與糖尿病有關的經驗態度量表得分之檢定 67 表4-23 與糖尿病有關的經驗行為傾向量表得分之檢定 68 表4-24 校護對照護糖尿病學童之知識與態度的相關分析 69 表4-25 校護對照護糖尿病學童之知識與行為傾向的相關分析 70 表4-26 校護對照護糖尿病學童之態度與行為傾向的相關分析 71 表4-27 校護對照護糖尿病學童之知識、態度與行為傾向的相關矩陣 711222570 bytesapplication/pdfen-US學校護士知識行為傾向態度糖尿病學童attitudeknowledgeschool children with diabetesbehavior intentionschool health nurse[SDGs]SDG3otherhttp://ntur.lib.ntu.edu.tw/bitstream/246246/55751/1/ntu-93-R91426023-1.pdf