黃秀梨臺灣大學：護理學研究所曾雅涓Tseng, Ya-ChuanYa-ChuanTseng2007-11-272018-07-072007-11-272018-07-072006http://ntur.lib.ntu.edu.tw//handle/246246/55780病人因緊急情況或意外傷害到急診室就醫，醫護人員大多將重點放在病人醫療處置上，家屬隔離在急救室外，家屬的需求經常被忽視。本研究目的在探討急診重症病人家屬需求重要性及需求獲得滿足程度，並比較護理人員與家屬之間對需求重要性及獲得滿足程度的認知差異。研究採描述比較性、橫斷面式結構問卷調查法，以「重症病人家屬需求量表」為研究工具（分家屬版與護理人員版），立意取樣選取北部某醫學中心急診室70位重症病人家屬與70位急診護理人員，探討其對家屬需求重要性及需求獲得滿足程度之認知，並以描述性統計、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關與階層式複迴歸統計方式進行資料分析。 研究結果顯示：（1）家屬認知需求重要性平均得分為8.03分，護理人員認知家屬需求重要性平均得分為7.05分，皆認知「溝通與訊息獲得」需求重要性最高，「舒適」需求重要性最低。（2）家屬認知需求獲得滿足程度平均得分為7.12分，護理人員認知家屬需求獲得滿足程度平均得分為6.17分，皆認知「溝通與訊息獲得」需求獲得滿足程度最高，「舒適」需求獲得滿足程度最低。（3）家屬與護理人員認知40項家屬需求重要性中，有25項達顯著差異，且大多為家屬認知需求重要性得分高於護理人員；家屬與護理人員認知40項家屬需求獲得滿足程度中，有35項達顯著差異，且家屬認知需求獲得滿足程度得分亦高於護理人員。（4）家屬與護理人員認知需求重要性與需求獲得滿足程度呈顯著正相關，即認知需求重要性得分愈高，需求獲得滿足程度得分也愈高。（5）影響家屬認知需求重要性之因素為：家屬陪伴病人在急診時間、家庭平均月收入、家中人口數、家屬年齡及病人曾來急診次數。影響家屬認知需求獲得滿足程度之因素為：家屬性別以及家屬與病人居 住情形。（6）影響護理人員認知家屬需求重要性之因素為：護理人員婚姻狀況。影響護理人員認知家屬需求獲得滿足程度之因素為：護理人員年齡、急診工作年資以及護理工作總年資。（7）家屬認知需求重要性之重要預測變項有：「家屬陪伴病人在急診時間」、「家屬年齡」、「家中人口數」及「家屬是否為主要照顧者」，可解釋總變異數48.8％。家屬認知需求獲得滿足程度之重要預測變項有：「家屬性別」、「家屬年齡」及「家屬與病人居住情形」，可解釋總變異數37％。（8）護理人員認知家屬需求獲得滿足程度之重要預測變項有：「急診工作年資」及「護理工作年資」，可解釋總變異數35.9％。本研究結果協助護理人員暸解急診重症病人家屬需求，提供未來照護家屬的重要參考依據，幫助家屬發展合適的因應能力與調適行為，共同維護病患健康與福祉。When a patient appears in the emergency room for emergency situations or accidents, the medical team usually only focuses on the medical situation of the patient, leaving the patient’s family members outside the emergency room and neglected. The purpose of this study is to identify the needs important of family members of critical patients, and the level to which such needs are satisfied. Also, the differences of family need perception assessed between these two groups are compared. This study is a cross-sectional design with a descriptive comparison approach, using the structured questionnaires of Critical Care Family Needs Inventory－Emergency Department (with different versions for family members and nurses) as our main research tool. All subjects are recruited from the emergency room of medical center in northern Taiwan, using a purposive sampling method. Seventy family members of critical patients and seventy nurses in the emergency room are recruited. The data is analyzed by using descriptive statistics, independent t test, one-way ANOVA, Pearson’s correlation and hierarchical multiple regression analysis. The results show that:（1）The mean score of the needs importance for the family members is 8.03, and for the nurses is 7.05. Both groups rank order needs importance for “communication with family members” the highest and needs importance for “comfort” the lowest.（2）The mean score of the needs satisfaction for the family members is 7.12, and for the nurses is 6.17. Both groups rank order needs satisfaction for “communication with family members” the highest and needs satisfaction for “comfort” the lowest.（3）Out of 40 categories being presented to the family members and nurses, there exists significant differences in needs importance score of 25 categories by the two groups, mainly with family members deciding that a certain category is more important than what nursing staff thought. Out of the level of satisfaction of the same 40 categories, 35 statements showed significant differences in mean scores by family members and by nurses. The finding indicate that family members rated the needs mean score of the needs satisfaction higher than the nurses .（4）There exists a positive correlation between the needs importance score and the needs satisfaction score for both groups, meaning that the higher the needs importance score for a category, the higher the needs satisfaction score for that same category.（5）The influencing factors of needs importance in family members includes: amount of time family members spent with patients in emergency room, average family monthly income, number of family members, age of family members, and number of times patient has been to the emergency room. The influencing factors of needs satisfaction in family members includes: sex of family member and living situation of the family member with the patient.（6）The influencing factors of needs importance in nurses includes: nurses’ marital status. The influencing factors of needs satisfaction in nurses includes: age of nursing staff, length of experience in the emergency room and length of experience in nursing.（7） Predictors of needs importance in family members includes: amount of time members spent with patient in emergency room, age of member, family size, and whether the family member is the primary care provider for the patient, accounting for 48.8% of total variation. Predictive factors for family members’ needs satisfaction score includes: age, sex and residency of family member, accounting for 37% of total variation.（8）Predictors of needs importance for nurses’ needs satisfaction score includes: length of experience in the emergency room and length of experience in nursing, accounting for 35.9% of total variation. These findings can serve as a useful reference for future application in effective family members care and assist nurses to understand the needs of family members. Results of this study may be of use to clinical nurses in helping family members in forming appropriate responses and making reasonable adjustments, so as to work together for the good of the patient.口試委員會審定書 I 誌 謝 II 中文摘要 III ABSTRACT V 目 錄 VII 表 目 錄 X 圖 目 錄 XII 第一章 緒論 1 第一節 研究背景及動機 1 第二節 研究目的 4 第三節 研究問題 5 第四節 研究假設 6 第五節 名詞解釋 7 第二章 文獻查證 9 第一節 需求的概念 9 第二節 急診對病人家屬影響 13 第三節 急診重症病人家屬的需求 15 第四節 護理人員對急診重症病人家屬需求的認知 22 第五節 病人家屬與護理人員對家屬需求認知差異 24 第六節 影響病人家屬與護理人員認知家屬需求之因素 26 第三章 研究方法與過程 35 第一節 研究概念架構 35 第二節 研究設計 36 第三節 研究場所及研究對象 37 第四節 研究工具 39 第五節 工具信效度檢定 43 第六節 資料收集過程 49 第七節 資料統計與分析 53 第四章 研究結果 58 第一節 研究對象基本資料 58 第二節 急診重症病人家屬與護理人員對家屬需求重要性之認知 64 第三節 急診重症病人家屬與護理人員對家屬需求獲得滿足程度之認知 71 第四節 急診重症病人家屬與護理人員認知需求重要性與獲得滿足程度之相關性 77 第五節 影響認知需求重要性之因素 81 第六節 影響認知需求獲得滿足程度之因素 90 第七節 急診重症病人家屬認知需求重要性及需求獲得滿足程度之預測因子 100 第八節 急診護理人員認知家屬需求重要性及需求獲得滿足程度之預測因子 106 第五章 討論 109 第一節 急診重症病人家屬與護理人員對家屬需求重要性之認知 109 第二節 急診重症病人家屬與護理人員對家屬需求獲得滿足程度之認知 116 第三節 急診重症病人家屬與護理人員認知需求重要性與獲得滿足之相關性 120 第四節 影響認知需求重要性之因素 121 第五節 影響認知需求獲得滿足之因素 124 第六節 急診重症病人家屬認知需求重要性及需求獲得滿足程度之預測因子 127 第七節 急診護理人員認知家屬需求重要性及需求獲得滿足程度之預測因子 129 第六章 結論與建議 130 第一節 結論 130 第二節 護理上應用之建議 132 第三節 研究限制與未來建議 134 參考資料 135 中文資料 135 英文資料 139 附 錄 145 附件一 問卷內容專家效度名單 145 附件二 急診重症病人家屬需求問卷 147 附件三 急診護理人員認知家屬需求問卷 163 附件四 研究工具引用申請書 177 附件五 研究工具引用同意書 179 附件六 至研究醫院收案之公函 181 附件七 研究醫院同意書 1835376768 bytesapplication/pdfen-US急診室家屬護理人員需求重要性需求獲得滿足程度Emergency RoomFamily membersNursesNeeds importanceNeeds satisfactionotherhttp://ntur.lib.ntu.edu.tw/bitstream/246246/55780/1/ntu-95-R91426016-1.pdf