[[alternative]]The Oral Hygiene Care Related Practices in Institutional Caregivers for Elderly Residents

Abstract

[[abstract]]口腔健康照護行為屬長期照護施行之一環，其應有必然之定位與重要性。本研究旨在瞭解長期照護機構照服員對住民口腔健康照護行為及相關因素，並探討其周邊之事項、因素或條件之關聯性。研究採橫斷性設計，方便取樣方式，透過參採國內外之經驗再經專家效度檢證之結構式問卷，針對照護滿三個月以上之照服員進行觀測。研究共收到110份問卷，並同時回顧檢視機構住民共380份照護病歷，擇取住民當下疾病罹患(CCI-Q)及活動功能(ADL /IADL) 屬性，予以描述及分析統計。 研究結果發現長期照護機構照服員口腔衛生保健知識(K)、態度(A)、(執行)行為(P)三者互相正面扣聯。口腔衛生保健知識得分愈高者，態度愈積極正向，在行為的執行上也較良好。本研究發現照服員普遍年齡偏高、女性、高中程度、以二度就業居多。其在「工作特質」中工作時數以12小時居多、照顧人數以5~10人為為主，口腔照護執行時間以3~5分鐘、次數1~2次，故口腔照護時間與頻率並不長；知識方面之答對率為66％，顯示照服員於口腔衛生保健知識不若預期，而照服員教育程度、是否為正編人員，與其口腔照護知識呈正相關；但在照服員自覺性照護困擾中，住民退化程度與口腔衛生知識呈負相關。態度方面總得分平均值為52.7，顯示態度或有強化之空間，研究發現照服員人研習次數(頻度)、自覺住民退化程度、合併罹病指數、知識分數等，均與態度呈顯著正相關；但在照服員人口特性中性別、本身罹患慢性病與態度呈負相關，分析發現男性比女性照服員在口腔態度上較為遜色。在口腔照護行為上與照服員使用慢性病藥物與口腔態度呈正相關，其餘人口特性、工作特質與住民功能屬性，在口腔照護行為上不具顯著預測力。 整體而言，國內長期照護機構中口腔衛生照護執行所佔長期照護比重仍偏低，已明顯邊緣化或甚至其可有可無，研究發現照服員對於口腔衛生保健知識、態度與(執行)行為或顯不足，除本然透過在職教育與實務訓練強化外，尚需重視照服員人力之工作保障，應強化照服員(半)專業定位與社會價值，並設計建立照服員照護(半)專業能力分級制度，以提高其薪資、工作地位與社會價值，並最好能將照服員之培訓養成納入正規技職體系教育再以補強式之啟蒙、通識、大眾化及(半)專業延續再教育之設計，以因應未來長期照護政策之推動與高齡化社會所需之大量合宜之照顧人力，如此才能期待其永續發展與確保照護之品質。[[abstract]]Oral healthcare is just one part of long-term care with importance and its specific status. The study was aimed to explore, on oral healthcare, the performance and the related factors among the 1st line careworkers(main caregivers) in long-term care facilities. The study had been organized a cross-sectional design, observing and interviewing the oral healthcare on arbitrarily sample subjects with working experience more than 3 months through a professional／specialist-validified structured questionnaire, adapted from those of foreign advanced counterparts for reference. Totally 110 subjects responded and concurrently reviewing 380 related care records of the facility residents to document CCI-Q (Charlson co-morbidity index by Quan) and ADL/IADL (activity of daily living and instrumental activity of daily living) into data file for description and analysis. The study results show that the oral healthcare knowledge (K), attitude (A), and performance (P) of caregivers were positively linked together, i.e. those with a higher score in oral healthcare knowledge have a more positive attitude and better performance. The study found that most care-givers were female, not young, with senior high-school education background; and be re-employed or second career in their life. And, each had taken care of 5-10 residents, daily work hours 12 mostly, only offering 3-5 minutes of oral healthcare 1-2 times daily. The length and frequency of oral healthcare be short and low. In term of knowledge, the correct response rate was 66%, just lower than expected; their education background and employment status (official employee) were positively correlated with oral healthcare knowledge. In their self-perceived difficulty, the degeneration status, CCI-Q and oral healthcare were negatively correlated. The mean score in attitude was 52.7, just implying its empowering potential. The results also showed that the training frequency, self-perceived degeneration, CCI-Q, and knowledge score of care-givers were all positively correlated with attitude. Rather, gender and chronic condition status were negatively correlated with attitude, i.e. with poorer attitude in male than in female. Oral healthcare performance is positively correlated with the medication on their chronic conditions and attitude. As for other demographics, care-works, health function of residents seemed without any predictivity for the study. Eventually, oral healthcare comprised a relatively lower proportion of ordinary care supply in long-term care facility in Taiwan, even marginalized or not indispensable whatever. The study showed that the oral healthcare knowledge, attitude, and performance for care-givers were somewhat inadequate. In order to upgrade their income, the working and social status, apart from on-job education and practical training, the nurturing of care workers should be launched under the formal vocational education system, and empowering in the course of elementary, generalized, public education, and (quasi-) professional on-job or re-education design, to cope with the progression of long-term care policy and the mandatory lots of human resources of care-works required in an ageing／aged society. it would be essential to reinforce the job ensuring for care-givers, its social value, (quasi-)professional status of care-works, and the designing of competence leveling of care-works. Hence, we could refer to the sustainable development and quality of long-term care