臺灣博碩士論文加值系統

研究背景：吸菸不僅對健康造成威脅，同時也造成龐大醫療支出並阻礙經濟的發展。由於吸菸依賴是一個包含行為、認知、生理的複雜現象，所以要協助吸菸者成功的戒菸，就需要了解護理人員提供戒菸服務與提供戒菸服務的自我效能之概況。本研究目的為了解護理人員對COPD病人提供戒菸服務與自我效能的狀況及其相關因素的探討。
研究方法：採立意取樣之橫斷式相關性研究。以南部某區域教學醫院的胸科內科、門診護理人員為研究對象，以結構式問卷進行資料收集，發放75份問卷，有效問卷72份，回收率為96%，以統計軟體SPSS 24.0進行分析。
研究結果：1. 本研究之護理人員以女性為主。工作年資、教育程度、年齡、提供戒菸服務作法與戒菸服務的自我效能沒有顯著相關。2.護理人員提供個案戒菸協助之平均得分1.32±1.11分（滿分5分）；無任何因素與「護理人員提供個案戒菸的協助」有關。3.護理人員與個案討論戒菸問題之平均得分1.38±1.13分（滿分5分）；「護理人員與個案討論戒菸或減菸的頻率」、「護理人員提供戒菸的方法」、「達到減菸意圖」為護理人員提供討論戒菸問題的相關因素。4.護理人員自評提供戒菸服務的自我效能之平均得分為48.06±17.98分（滿分100分）；胸腔內科護理人員遠低於門診護理人員自我效能之平均得分（45.07±17.78 vs. 53.67±16.84）；然而無任何因素與「護理人員提供戒菸服務的自我效能」有關。
結論/實務應用：胸腔內科護理人員提供戒菸服務與戒菸服務自我效能低於門診護理人員，故建議臨床上可針對胸腔內科護理人員安排相關在職教育如模擬體驗，提升護理人員照護知識、表達能力及批判性思考。也應在大學護理教育課程開設戒菸相關知識及人際溝通的課程，提升護理人員的尼古丁相關知識，提升自信心能力，建立良好的護病關係。

Background: Smoking not only threatens health but also poses enormous medical costs and hinders economic development. Smoking dependence is a complex phenomenon involving behavioral, cognitive, and physiological factors; therefore, to help smokers quit smoking successfully, it is necessary to understand the general status and self-efficacy of nursing staff providing smoking cessation services. This study aimed to understand the status of nursing staff providing smoking cessation services to patients with chronic obstructive pulmonary disease, the self-efficacy of the staff in providing these services, and related factors.
Methods: A cross-sectional, correlation study with purposive sampling was conducted. The nursing staff in the chest ward and outpatient clinics of a regional teaching hospital in southern Taiwan constituted the study population. Data were collected using a structured questionnaire. In total, 75 questionnaires were distributed, of which 72 were valid, resulting in a retrieval rate of 96%. SPSS 24.0 statistical software was used for analysis.
Results: 1. The study population mainly comprised females. The nursing staff’s working experience, education level, age, and the strategies of providing smoking cessation services were not significantly correlated with their self-efficacy in providing the services. 2. The average score of the nursing staff providing individual patients with assistance in smoking cessation was 1.32±1.11 points (maximum score: 5 points); no factor was found to be correlated with “nursing staff providing individual patients with assistance in smoking cessation.” 3. The average score of the nursing staff discussing smoking cessation issues with individual patients was 1.38±1.13 points (maximum score: 5 points); “the frequency of discussion between the nursing staff and individual patients regarding smoking cessation or reduction,” “the provision of methods for smoking cessation to individual patients by the nursing staff,” and “achieving the intention of smoking reduction” were the factors correlated with the nursing staff discussing smoking cessation issues with individual patients. 4. The average score of the nursing staff’s self-rated self-efficacy in providing smoking cessation services was 48.06±17.98 points (maximum score: 100 points); the average self-efficacy scores of the nursing staff in the internal medicine departments were significantly lower than that of the nursing staff in outpatient clinics (45.07±17.78 vs. 53.67±16.84). However, no factor was found to be correlated with “the nursing staff’s self-efficacy in providing smoking cessation services.”
Conclusion/practical application: The self-efficacy of the nursing staff in the chest ward was lower than that of the nursing staff in outpatient clinics in providing smoking cessation services. Therefore, relevant on-the-job clinical training, such as simulated experience, should be provided to the nursing staff in the thoracic medicine or chest ward to improve their nursing knowledge as well as expression and critical thinking abilities. Furthermore, courses on smoking-related knowledge and interpersonal communication must be integrated into nursing education programs in higher education institutions so as to improve the nicotine-related knowledge and enhance the self-confidence and ability of nursing staff and to help them establish a good nurse–patient relationship.

目次
誌謝 I
中文摘要 II
ABSTRACT III
目次 V
表目次 VII
圖目次 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究問題 3
第二章 文獻查證 4
第一節 吸菸對COPD的健康影響及現況 4
第二節 COPD病人對戒菸的態度與現況 6
第三節 影響護理人員提供病人戒菸服務自我效能之因素 8
第三章 研究方法 12
第一節 研究設計與研究對象 12
第二節 研究概念架構 13
第三節 名詞解釋 14
第四節 研究工具 16
第五節 資料分析 17
第四章 研究結果 19
第一節 社會人口學分佈 19
第二節 護理人員認為影響COPD個案戒菸因素 24
第三節 護理人員對COPD個案吸菸的態度及信念 27
第四節 護理人員對COPD個案抽菸實務作法之關係 29
第五節 護理人員對COPD個案提供戒菸服務作法、提供戒菸服務自我效能之相關性 33
第六節 預測護理人員對COPD個案提供戒菸服務作法與自我效能之因素 35
第五章 討論 39
第六章 結論與建議 44
第一節 結論 44
第二節 研究應用與建議 45
第三節研究限制 46
參考文獻 47
中文部分 47
附錄 52
表目次
表3-5-1研究問題及統計方法 18
表4-1-2基本人口學資料連續變項分佈情形 22
表4-1-3 護理人員對COPD個案提供戒菸服務作法 22
表4-1-4護理人員提供戒菸服務的自我效能之比較） 23
表4-2-1護理人員認為影響個案戒菸得分情況 25
表4-3-1 護理人員認為個案吸菸的理由 27
表4-4-1護理人員對個案抽菸的務實作法比較分析 31
表4-4-2護理人員自評協助個案成功戒菸或減菸之比較分析 32
表4-5-1護理人員與COPD個案討論戒菸方法與自我效能之關係 34
表4-6-1影響護理人員提供個案戒菸協助之預測變項 36
表4-6-2影響護理人員與個案討論戒菸問題之預測變項 36
表4-6-3影響胸腔內科護理人員提供自我效能之預測變項 37
表4-6-4影響門診護理人員提供戒菸服務的自我效能之預測變項 38
表4-6-5影響護理人員提供自我效能之預測變項) 38

圖目次
圖2-3-1自我效能概念圖 9
圖3-2-1研究架構 13

中文部分
王心榆（2017）．菸害防制政策對吸菸者吸菸行為影響之研究中華科技大學．台北市https：//hdl.handle.net/11296/5w7wfx
王愛玲、郭素娥、方素瓔、李世凱、徐畢卿（2012）．戒菸服務自我效能量表-精神衛生臨床專業人員版之中文版發展與信效度檢定．護理雜誌，59（5），49-56。
王愛玲. (2010)．台灣精神科護理人員提供戒菸服務的自我效能及相關因素之探討．國立成功大學．台南市. https：//hdl.handle.net/11296/ex7c2p。
台灣胸腔暨重症加護醫學會（2020，5月13日）．2019 COPD臨床照護指引．取自https：//www.tspccm.org.tw/km/1029。
崔禾、王采芷（2018)）．COPD患者戒菸行為及其相關因素探討．台灣專科護理人員學刊，5（1），24-35。
阮妙嬋（2014）．東部精神科護理人員施行戒菸服務知識、態度與自我效能之影響因素 ．美和科技大學．屏東縣. https：//hdl.handle.net/11296/r635f5。
衛生福利部國民健康署（2020年5月），「 國人吸菸行為調查結果」取自 https：//www.gender.ey.gov.tw/gecdb/Stat_Statistics_DetailData.aspx?sn=ORVNSDIGVFTYgkN%2B7bdIyA%3D%3D。
衛生福利部國民健康署(2017年3月) ，戒菸增健康 補助升級、效益提升、
民眾滿意，助您好戒!取自https：//www.hpa.gov.tw/Pages/Detail.aspx?
nodeid=1089&pid=6414
衛生福利部國民健康署（2020年5月），「2018台灣菸害防制年報」取自 https：//health99.hpa.gov.tw/educZone/edu_detail.aspx?CatId=22076。
衛生福利部國民健康署（2020年5月），「國人死因統計」取自 https：//www.mohw.
gov.tw/cp-16-48057-1.htm。
英文部分
Andreas, S., Hering, T., Mühlig, S., Nowak, D., Raupach, T., & Worth, H. (2009). Smoking cessation in chronic obstructive pulmonary disease： an effective medical intervention. Deutsches Ärzteblatt international, 106(16), 276.
Bandura, A. (1977). Self-efficacy： toward a unifying theory of behavioral change. Psychological review, 84(2), 191.
Bandura, A. (1982). The assessment and predictive generality of self-percepts of efficacy. Journal of behavior therapy and experimental psychiatry, 13(3), 195-199.
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ7 Prentice-Hall. In： Inc.
Bandura, A. (1995). Comments on the crusade against the causal efficacy of human thought. Journal of behavior therapy and experimental psychiatry, 26(3), 179-190.
Bandura, A. (1997). The anatomy of stages of change. American journal of health promotion： AJHP, 12(1), 8-10.
Bandura, A. (2004). Health promotion by social cognitive means. Health education & behavior, 31(2), 143-164.
Bernal, H., & Froman, R. (1987). The confidence of community health nurses in caring for ethnically diverse populations. Image： The Journal of Nursing Scholarship, 19(4), 201-203.
Chatdokmaiprai, K., Kalampakorn, S., McCullagh, M., Lagampan, S., & Keeratiwiriyaporn, S. (2017). Factors predicting the provision of smoking cessation services among occupational health nurses in Thailand. Workplace Health & Safety, 65(6), 253-261.
Cheng, S.-L., Chan, M.-C., Wang, C.-C., Lin, C.-H., Wang, H.-C., Hsu, J.-Y., . . . Yu, C.-J. (2015). COPD in Taiwan： a national epidemiology survey. Int J Chron Obstruct Pulmon Dis, 10, 2459.
Choi, S.-H., & Kim, Y.-H. (2016). Factors affecting Korean registered nurses' intention to implement smoking cessation intervention. Osong public health and research perspectives, 7(1), 63-70.
Cox, K. (2011). Smoking cessation buddies in COPD. Nurs Times, 107(44), 22-23.
Efraimsson, E. O., Fossum, B., Ehrenberg, A., Larsson, K., & Klang, B. (2012). Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. J Adv Nurs, 68(4), 767-782. https：//doi.org/10.1111/j.1365-2648.2011.05766.x
Efraimsson, E. O., Klang, B., Ehrenberg, A., Larsson, K., Fossum, B., & Olai, L. (2015). Nurses' and patients' communication in smoking cessation at nurse-led COPD clinics in primary health care. Eur Clin Respir J, 2, 27915. https：//doi.org/10.3402/ecrj.v2.27915
Eklund, B.-M., Nilsson, S., Hedman, L., & Lindberg, I. (2012). Why do smokers diagnosed with COPD not quit smoking?-a qualitative study. Tobacco induced diseases, 10(1), 1-7.
Goodchild, M., Nargis, N., & d'Espaignet, E. T. (2018). Global economic cost of smoking-attributable diseases. Tobacco control, 27(1), 58-64.
Hirayama, F., Lee, A. H., Binns, C. W., & Tanikawa, Y. (2008). Persistent smoking by Japanese patients within four years from diagnosis of chronic obstructive pulmonary disease. Addictive behaviors, 33(9), 1235-1238.
Jha, P., & Peto, R. (2014). Global effects of smoking, of quitting, and of taxing tobacco. New England Journal of Medicine, 370(1), 60-68.
Jiménez-Ruiz, C. A., Masa, F., Miravitlles, M., Gabriel, R., Viejo, J. L., Villasante, C., . . . Investigators, I. S. (2001). Smoking characteristics： differences in attitudes and dependence between healthy smokers and smokers with COPD. Chest, 119(5), 1365-1370.
Johnson, J. L., Malchy, L. A., Ratner, P. A., Hossain, S., Procyshyn, R. M., Bottorff, J. L., . . . Schultz, A. (2009). Community mental healthcare providers’ attitudes and practices related to smoking cessation interventions for people living with severe mental illness. Patient Educ Couns, 77(2), 289-295.
Jonsdottir, R., & Jonsdottir, H. (2007). The experience of women with advanced chronic obstructive pulmonary disease of repeatedly relapsing to smoking. Scandinavian journal of caring sciences, 21(3), 297-304.
Lim, S., Lam, D. C.-L., Muttalif, A. R., Yunus, F., Wongtim, S., Shetty, V., . . . De Guia, T. (2015). Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region： the EPIC Asia population-based survey. Asia Pacific family medicine, 14(1), 4.
Mackereth, P., Finchett, C., & Holt, M. (2016). Smoke-free hospital site conversations： how nurses can initiate change. Br J Nurs, 25(21), 1176-1180. https：//doi.org/10.12968/bjon.2016.25.21.1176
Mak, Y. W., Loke, A. Y., & Wong, F. K. (2018). Nursing intervention practices for smoking cessation： a large survey in Hong Kong. International journal of environmental research and public health, 15(5), 1046.
Meijer, E., van der Kleij, R., Segaar, D., & Chavannes, N. (2019). Determinants of providing smoking cessation care in five groups of healthcare professionals： A cross-sectional comparison. Patient Educ Couns, 102(6), 1140-1149.
Moreira, G. L., Gazzotti, M. R., Manzano, B. M., Nascimento, O., Perez-Padilla, R., Menezes, A. M. B., & Jardim, J. R. (2015). Incidence of chronic obstructive pulmonary disease based on three spirometric diagnostic criteria in Sao Paulo, Brazil： a nine-year follow-up since the PLATINO prevalence study. Sao Paulo Medical Journal, 133, 245-251.
Ørts, L. M., Bech, B. H., Lauritzen, T., Carlsen, A. H., Sandbæk, A., & Løkke, A. (2020). Lung function in adults and future burden of obstructive lung diseases in a long-term follow-up. NPJ Prim Care Respir Med, 30(1), 1-8.
Peiffer, G., Underner, M., & Perriot, J. (2018). [COPD and smoking cessation： Patients' expectations and responses of health professionals]. Rev Pneumol Clin, 74(6), 375-390. https：//doi.org/10.1016/j.pneumo.2018.10.001 (BPCO et sevrage tabagique ： attentes des patients et reponses des professionnels de sante.)
Sarna, L., Bialous, S. A., Wells, M., Kotlerman, J., Wewers, M. E., & Froelicher, E. S. (2009). Frequency of nurses' smoking cessation interventions： report from a national survey. Journal of Clinical Nursing, 18(14), 2066-2077. https：//doi.org/10.1111/j.1365-2702.2009.02796.x
Sarna, L. P., Bialous, S. A., Kraliková, E., Kmetova, A., Felbrová, V., Kulovaná, S., . . . Brook, J. K. (2014). Impact of a smoking cessation educational program on nurses’ interventions. Journal of Nursing Scholarship, 46(5), 314-321.
Svanes, C., Sunyer, J., Plana, E., Dharmage, S., Heinrich, J., Jarvis, D., . . . Antó, J. M. (2010). Early life origins of chronic obstructive pulmonary disease. Thorax, 65(1), 14-20. https：//doi.org/10.1136/thx.2008.112136
Tremblay, M., Cournoyer, D., & O’Loughlin, J. (2009). Do the correlates of smoking cessation counseling differ across health professional groups? Nicotine & Tobacco Research, 11(11), 1330-1338. https：//doi.org/10.1093/ntr/ntp142
World Health Organization. (2019). Fact sheet on tobacco. http：//www.who.int/ mediacentre/factsheets/fs339/en/
World Health Organization. (2018) .Fact sheets.Chronic obstructive pulmonary disease(COPD).https：//www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
Wetta-Hall, R., Ablah, E., Frazier, L. M., Molgaard, C. A., Berry, M., & Good, M. J. (2005). Factors Influencing Nurses' Smoking Cessation Assessment and Counseling Practices. Journal of Addictions Nursing, 16(3), 131-135. https：//doi.org/10.1080/10884600500203655