護理學系HU, WEN-YUWEN-YUHUTSENG, CHIEN-NINGCHIEN-NINGTSENGWANG, YUYUWANGWENG, JUI-HSUANJUI-HSUANWENG胡文郁曾建寧王浴翁瑞萱2009-09-132018-07-072009-09-132018-07-072004http://ntur.lib.ntu.edu.tw//handle/246246/166120本研究旨在探討醫學院護生對安寧緩和醫療的認知、態度以及末期照顧倫理情境認同 度，以及護生經過安寧緩和醫療臨床實習教育介入的成效。本研究對象為民國九十一 年學年度護理學系「內外科護理學實習」必修課程中37位大三學生，採雙組前後測準 實驗設計，其中19位被安排至安排至安寧緩和醫療病房為期四至五週的臨床實習為實 驗組，餘18位則在一般內外科病房實習為對照組。以Wilcoxon Signed Ranks test進 行前後測總平均等級之差異檢定，重要結果為護生在透過實際與照顧末期病人的安寧 緩和醫病臨床實習，確實可以1)提高護生對於安寧緩和醫療的認知（Z=-3.527，P<. 001）；2)改變其對安寧緩和醫療趨於正向的態度（Z=-1.675，P<0.05），即降低護 生對癌末病人帶來的威脅性感受，以及護生對提供安寧緩和醫療好處的感受提高並對 壞處的感受降低；3)提高護生對末期病人「不宜使用人工營養及水分的倫理」認同度 最低（Z=-2.736，P<0.01）；4)護生對「與癌末病人溝通的技巧」、「身體不適症狀 處理」以及「心理情緖支持的方法」有較高的末期教育需求5)護生對安寧緩和 醫療的雨度分別與倫理情境認同度和教育需求間呈正相關（r=0.63，p<0.01；r=0. 53，p<0.05）。建議未來應舉辦末期照顧之種子教師師資培訓，本研究結果可供未來 在推展醫學院校大學部安寧緩和醫療護理教育課程之參考。 The objectives of this study were to evaluate the effects in knowledge, attitudes, and ethical issues of student nurses. Form 2002 to 2003, thirty-seven student nurses was enrolled in a four or five weeks course of clinical practice for “Medical-Surgical Nursing” in the hospice palliative care unit of the NATIONAL Taiwan University Hospital. The questionnaire, assessing student nurses’ knowledge and attitudes towards towards ethical dilemmas, was used to assess philosophy and clinical management, and attitudes regarding common ethical issues before and after the educational intervening program. The Wilcoxon Signed Ranks test was used to examine pre-and post- training composite score. The findings showed that the clinical practice heighten the knowledge and attitudes for palliative care in student nurses (Z=-3.527, P<.001; Z=-1. 750, P<0.05). Regarding attitudes for the student nurses towars the ethical dilemmas of artificial hydration and nutrition, in which was not of benefit in terminal patients , had increased in student nurses after clinical practice program. The three leading educational needs were communicative skills, management of physical discomfort and methods of emotional support. The attitudes of palliative care positively correlated with the agreement of ethical issues and educational needs (r=0.63, p<0.01; r=0.53, p<0.05 ). It was suggested to hold a seminar toward the end-of-life care for clinical tutors. The results of this study should encourage those providing or planning in training opportunities for student nurses in the area of end-of-life.en-US安寧緩和醫療護生知識態度教育需求hospice palliative care