背景：全人照護(Holistic Care)是一種綜合照護模式，包括身、心、靈與社會，安寧緩和醫療是全人照護的一部分，提升病人的生活品質，減少過度醫療，而護理人員是提供全人照護的主要群體。現今高齡化及非傳染性疾病的負擔增加，安寧緩和治療的需求大幅增長。

目的：台灣對安寧照護越受重視及國外許多研究表明護理人員對全人照護的理解和執行相對較薄弱，故本研究想了解安寧護理人員對全人照護的看法及行為方式，與執行上遇到的挑戰或困難，找出困難點，協助讓工作更順利。

方法：本研究對象為安寧護理人員，為深入了解看法及行為，以問卷設計和質性訪談兩階段混和進行研究，並以跨院多機構方式，樣本來自某南部醫學中心及其合作之區域、地區醫院及醫學中心，採用知識、態度、行為理論進行分析。

結果：問卷顯示出知識、態度、行為三者皆會互相影響，其中態度具有完全中介效果，另外接受教育訓練對態度及行為具有顯著影響，而訪談顯示受訪者的看法及行為皆很類似，且病人的家屬問題是首要的挑戰。

結論：透過研究了解安寧護理人員對全人照護看法及行為，找出在執行上遇到的困難與挑戰，建立適當的教育訓練及管理系統，將促使護理人員提供全人照護並提高照護品質。

Background: Holistic care is a comprehensive care model, including the body, mind, spirit and society. Palliative care is part of holistic care, improving patients' quality of life, and reducing overuse medical care. Nurses are the primary group providing holistic care. With the increasing burden of aging and non-communicable diseases, the demand for palliative care has grown significantly.

Purposes: Taiwan's growing emphasis on palliative care and many foreign studies have shown that nurses’ understanding and implementation of holistic care are relatively weak. Therefore, this study aims to understand hospice nurses' perceptions and behaviors of holistic care and the challenges or difficulties encountered in implementation to identify the difficulties and help make the work smoother.

Methods: The subjects of this study were hospice nurses. In order to deeply understand their views and behaviors, the study was divided into two phases of questionnaire design and qualitative interview according to different purposes. The samples were from a southern medical center and its cooperative district hospitals, regional hospitals, and medical centers in a cross-hospital and multi-institutional manner. The knowledge, attitude, and behavior theory were used for analysis.

Results: The questionnaire results indicate that knowledge, attitude, and behavior mutually influence each other, with attitude acting as a complete mediator. Additionally, receiving educational training has a significant impact on both attitude and behavior. In the interviews, the respondents' perspectives and behaviors were quite similar. Furthermore, the foremost challenge identified was related to the patient’s family members.

Conclusions: Through research to understand hospice nurses' perceptions and behaviors on holistic care, find out the difficulties and challenges encountered in implementation, and establish appropriate education training and management systems, which will promote nurses to provide holistic care and improve the quality of care.

論文審定書 i
摘 要 ii
Abstract iii
目 錄 iv
圖 次 vi
表 次 vii
第一章：緒論 1
第一節 研究背景與動機 1
第二節 研究問題 3
第三節 研究重要性與目的 3
第二章：文獻探討 5
第一節 全人照護定義與概念 5
第二節 安寧緩和醫療之意涵與發展 7
第三節 護理人員在全人照護中的作用 9
第四節 醫護人員知識、態度、行為之相關性 10
第五節 安寧護理人員執行全人照護所遇到的挑戰 12
第六節 總結 13
第三章：研究方法 14
第一節 研究流程與架構 14
第二節 研究設計 17
第三節 資料處理與統計分析 30
第四節 研究倫理 31
第四章：研究結果 33
第一節 量性問卷研究結果 33
第二節 質性訪談研究結果 59
第五章：討論 73
第一節 假說驗證 73
第二節 結果討論 74
第六章：結論與建議 81
第一節 結論 81
第二節 研究限制 82
第三節 研究貢獻 82
第四節 建議 83
參考文獻 85
附錄一：問卷 95
附錄二：訪談大綱 101
附錄三：人體研究計畫同意函 102

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