探討鼻胃管留置病人出院主要照顧者對鼻胃管灌食照護之認知、焦慮與學習需求

背景及目的： 隨著台灣人口逐漸步入老化，因著疾病本身影響而產生吞嚥障礙、或是因病無法由口進食，因而需要長期依賴留置鼻胃管路，以灌食方式來維持營養的人數與日俱增。由於主要照顧者對於鼻胃管灌食的認知不足，因而造成其在醫療照護上的焦慮與相關技能學習需求不足，就有可能因此影響病人安全，甚至增加醫療量能的消耗。我們的研究宗旨在於探討鼻胃管留置病人出院之主要照顧者對鼻胃管灌食照護認知、焦慮感受與學習需求。研究方法： 本研究採橫斷式調查研究，於某中部地區醫院住院病房進行收案。共收案30位留置鼻胃管病人之主要照顧者為研究對象。以自擬結構式問卷進行資料收集。資料以SPSS 22.0版進行統計分析。研究結果：研究發現:鼻胃管留置病人平均年齡為77.53歲，且以中風診斷及男性病人居多。而主要照顧者多為已婚女性、高中以上教育程度者，73.3%為病人的子女或媳婦。主要照顧者焦慮程度與其照護認知呈現顯著負相關、與照護需求呈現顯著正相關。在照護認知方面，男性高於女性、教育程度為國小者之得分最低。而以首次照護者其焦慮程度最高、照護同時有鼻胃管和尿管病人的照護需求最高。整體而言，是否為第一次照顧(B=2.077, p =0.018)、整體照護認知(B=-.540, p = 0.018)與照護需求(B =.099, p = 0.012)為照顧者焦慮程度之顯著預測變項，共可解釋照護者焦慮70.2%的變異量。而主要照顧者焦慮程度（B=-.368, p = 0.041）與照護病人診斷為心臟疾病者（B=2.162, p = 0.043）為整體照護認知之顯著預測變項，共可解釋照護者認知50.2%的變異量。焦慮程度(B=2.289, p = 0.011）為照顧者整體需求程度之顯著預測變項，共可解釋照護者需求40.7%的變異量。結論與建議:整體而言，照護認知越高，照護者的焦慮程度通常越低，照護需求高低也會直接影響照護者的焦慮程度。因此，提升主要照護者的鼻胃管照護認知是減少其焦慮和降低照護需求的關鍵。本研究結果能提供臨床醫護在未來病人出院準備照護服務的實證醫學參考，未來臨床人員應特別著重第一次提供照護者進行有關鼻胃管照護之衛教，將有助於增加主要照顧者照護的照護認知以及減輕其照護焦慮，進而降低其出院後的照護需求。

Background and aim: Along with the increasing of aging people in Taiwan, more and more elderly patients need nasogastric intubation for feeding due to being difficult to swallow by themselves or resulting from diseases. Primary caregivers do not have sufficient cognition to the nasogastric intubation and it will result in more anxiety about the medical behaviors. Finally, it becomes the cause of more medical burden to take care of this kind of patient. Our study is designed to investigate factors of cognition and anxiety about nasogastric intubation and the learning needs of the primary caregivers facing patients with nasogastric intubation. Method: This is a cross-sectional study. There were 30 patients enrolled from a regional hospital in Central Taiwan. We collected all data from the self-designed questionnaire. All data was analyzed by SPSS 22.0 and we used the T-test, ANOVA, and Pearson Correlation for the statistic analysis.Result: The average age of patients with nasogastric tube placement is 77.53 years, with a majority being male patients diagnosed with stroke. The primary caregivers are mostly married women with at least a high school education, and 73.3% are the patients' children or daughters-in-law. The caregivers' anxiety levels are significantly negatively correlated with their caregiving knowledge and significantly positively correlated with caregiving demands. In terms of the caregivers’ knowledge, men scored higher than women, and those with only elementary education scored the lowest. First-time caregivers had the highest anxiety levels, and caregivers of patients with both nasogastric and urinary catheters had the highest caregiving demands. Overall, whether it was the first time caregiving (B=2.077, p=0.018), overall caregiving knowledge (B=-0.540, p=0.018), and caregiving demands (B=0.099, p=0.012) were significant predictors of caregiver anxiety levels, explaining 70.2% of the variance in caregiver anxiety. The primary predictors of overall caregiving knowledge were caregiver anxiety levels (B=-0.368, p=0.041) and whether the patient was diagnosed with heart disease (B=2.162, p=0.043), explaining 50.2% of the variance in caregiving knowledge. Anxiety levels (B=2.289, p=0.011) were a significant predictor of overall caregiving demands, explaining 40.7% of the variance in caregiving demands.We found that people who were on the first time to take care of patients with nasogastric intubation had the most severity of anxiety. People with more cognition to nasogastric intubation would have less stress due to this medical behavior. We also found that when people with more anxiety or less cognition to nasogastric intubation, they would have more need to learn the skill of this kind of medical procedure.Conclusion and suggestion : It is the key factor that if we improved the cognition of the nasogastric intubation for those primary caregivers, we could decrease the anxiety and the care burden of the primary caregivers to face the nasogastric intubation. We suggest that the medical staff will begin to empower the primary caregivers with the skill of nasogastric intubation as soon as possible. It would be helpful to decrease the medical burden of caregivers of patients discharged with a nasogastric tube.