多元創意衛教策略對呼吸器依賴主要照顧者之氣切認知與態度影響探討

背景與目的：據健保署2017年統計顯示，長期呼吸依賴(prolonged mechanical ventilation, PMV)醫療支出每年約140億，其醫療支出僅次於癌症，位居第二名。實證研究發現早期氣切，可提高呼吸器脫離率及降低肺炎及死亡的發生率，然台灣執行氣切的醫療決策大多仰賴主要照顧者。因此，本研究針對呼吸器依賴者及其主要照顧者的基本特性、呼吸器依賴疾病特性、運用多元創意衛教策略介入後，主要照顧者對氣切手術認知及態度的分佈，並進行分析介入前後影響主要照顧者對氣切認知與態度的相關及影響因素。.方法：研究採單組前後測實驗設計，以中山醫學大學附設醫院為收案地點，於2019年11月至2020年11月間，針對家屬插管大於21天且短暫無法脫離呼吸器之主要照顧者為對象，共完成34位收案。研究介入前以「呼吸器依賴主要照顧者對執行氣切認知與態度」量表進行前測，接著進行多元創意衛教策略介入，並於介入後一星期以同樣量表進行後測。回收資料以SPSS 22.0套裝軟體進行統計分析。結果：多元創意衛教介入前後的認知（t =4.21±4.08，p<.00)與態度（t=7.5±7.02，p<.00)差異比較，皆達統計上顯著。而疾病診斷不同會造成主要照護者對氣切手術之認知，在介入前（p=.03）及前後差（p=.04）皆有顯著差異。經事後比較發現呼吸器依賴者為神經/意外損傷診斷時，其主要照護者在介入前對氣切手術之認知分數顯著高於呼吸器依賴者為呼吸系統及腦心血管診斷者；女性在氣切態度改變分數的前後差，皆顯著大於男性（p=.00）。主要照顧者之年齡及子女數、教育程度等變項，對主要照顧者執行氣切手術態度之影響，在介入前、介入後及前後差，皆未達顯著差異水準（p=.25~.77）。結論與建議：隨著資訊科技日新月異的進步，發展出有別於傳統紙本的多元創意衛教策略。本研究運用影音媒體、體驗及同理心活動、提供單張及幫助記憶之順口溜等多元創意衛教方案的介入，能顯著提升主要照顧者對執行氣切手術的認知與態度。此研究結果有助於醫護人員日後執行氣切手術衛教時之參考依據，藉此提升呼吸依賴之主要照顧者，對氣切手術有正確的觀念，進而能改善病人的生活品質。

Background and Purpose：According to the statistics from the national health insurance agency in 2017, the annual expenditure for treating prolonged medical ventilation (PMV) patients was about 14 billion NTD, this expenditure was second only to the expenditure of treating the patients with cancer. The evidenced study had found that early tracheostomy could increase the chance of ventilator detachment and decrease the incidence of pneumonia and death. However, we’ve found that whether to undertake the tracheostomy depends heavily on the caregivers instead of the patients themselves. Therefore, this study intervenes with multi-creative health education strategies based on the characteristic of the patients and their primary caregivers and also the characteristic of the respirator depend. We analyze the primary caregiver’s cognition and attitude towards tracheostomy before and after the multi-creative health education strategy is intervened. We also search for the factors that affect the primary caregiver’s cognition and attitude towards tracheostomy.Method：A one-group pre-posttest experiment study design was adopted. Starting from November 2019 to December 2020, the study was conducted at Chung Shan Medical University Hospital (CSMUH). Targeting the patients who have been intubated for more than 21 days and were temporarily unable to detach the respirator, 34 participants (caregivers) had included. Before the intervention, the pre-test was conducted on the scale of “The caregiver’s cognition and attitude towards tracheostomy”, the post-test was conducted on the same scale one week after the intervention. Using the SPSS 22.0 software for data analysis.Results：The results shown that there was a statistically significant difference in the caregiver’s cognition（t =4.21±4.08，p<.00) and attitude（t =7.5±7.02，p<.00) towards tracheostomy, before and after the creative health education was intervened.Conclusions / Implications for Practice：The advancement of information technology rapidly, a diversified creative health education strategy different from traditional paper has been developed. We had used the multi-creative health education programs, including audio-visual media, experience and empathy activities, provision of leaflets, and jingle to help memory regarding the tracheostomy. The strategies mentioned above could be useful, as a reference for the medical staff when performing health education to the patients who rely on respirators and their caregivers. The strategies will promote the correctness of caregivers' concepts of tracheostomy, and improve the quality of life of patients.