本研究旨在探討護理人員與模擬癌症病人會談時所使用的溝通技巧與其相關因素之關係。為一描述性相關研究，採立意取樣，研究對象為高雄、台南不同層級之五家醫院的護理人員，研究工具包括醫學會談語言評量表、溝通能力量及情境特質焦慮量表，並藉由護理人員與模擬病人的會談錄影過程，以觀察軟體和運用醫學會談語言評量表進行編碼分析，計算護理人員的會談技巧及回應情緒線索行為的出現頻次，以描述性統計、Kruskal-Wallis Test、 Mann-Whitney U Test、皮爾森相關係數、複回歸及序列進行分析，了解在與模擬病人會談中護理人員所使用的溝通技巧、回應情緒線索行為、與病人情緒揭露等級的相關性，並找出預測護理人員溝通技巧的相關因素。
研究結果發現：（一）護理人員的年資、教育程度、溝通技巧學習經驗及情境焦慮與研究者所評量的醫學會談語言評量表總分達顯著相關。而情境/特質焦慮及自我感受支持總分與護理人員自評溝通能力達顯著相關。（二）研究者評量醫學會談語言評量表總分與護理人員自評溝通能力總分未達顯著相關。（三）工作環境、溝通學習經驗、工作年資、教育程度、情境焦慮及職稱是預測護理人員溝通技巧的重要因子，共可解釋41.2％護理人員溝通技巧的變異量。特質焦慮總分及自我感受到支持總分為護理人員自評基本溝通能力的預測因子，共可解釋18.1％變異量。（四）序列分析發現護理人員面對模擬病人情緒揭露等級一、二及三時皆會使用跳脫立場策略，而促進性技巧中以確認行為較能引發病人較高層次情緒等級之反應。本研究檢視護理人員與模擬病人溝通技巧的影響因素及溝通序列歷程，增進護理人員面對癌症病患情緒反應能力是很重要的技巧，未來擬根據重要預測因子設計增進護理人員的癌症溝通教育介入方案，作為腫瘤護理人訓培訓癌症方案，透過增進護理人員其溝通技巧，進而強化其護病關係與護理照護品質。

The purpose of this study was to examine the relationship of communication skills and related factors on nurses while interacting with simulated cancer patients.
A correlational descriptive research design with purposive sampling was applied for the current study. Subjects were recruited from the nurses having cancer care experiences in the 5 different levels of hospitals in Kaohsiung and Tainan. Instruments included Medical Interview Aural Rating Scale (MIARS), Kalamazoo Essential Elements Communication Checklist (KEECC), Nurses Self-perceived Support Scale (NSSS) and Sate-Trait Anxiety Inventory (STAI).
Observer Video-pro Software and MIARS were used to code and calculate the nurses’ communication skills and frequency of emotional cue responding behaveiors by two trained researchers through the videotaped interview. Data were analyzed by descriptive statistics, Kruskal-Wallis Test, Mann-Whitney U Test, Pearson correlation coefficient, Multiple regression and Sequential analysis. To examine the relationship between nurses’ communication skills and their cue responding behaviors and the level of emotional cues disclosing by simulated patients. Ihe predictors affecting communication skills on nurses while interacting with simulated cancer patients were identified.

The findings were: 1) Seniority, education, communication learning experiences and state anxiety were significantly correlated with researcher-rated MIARS. The STAI and NSSS support were significantly correlated with the self-rating KEECC by nurses. 2) There’s no significant correlation between researcher-rated MIARS and nurses’ self-rating KEECC. 3) Working environment, communication learning experience, seniority, education levels, state anxiety and position were the key factors affecting nurses’ communication skills, account for 41.2% predictive power. Trait Anxiety and NSSS predict the nurse self-rating KEECC, accounted for 18.1％. 4) Nurses using distancing strategy frequently while facing 1-3 levels of emotional cues revealed by patients were found by sequence analysis. While the nurse using acknowledge strategy, one of the facilitative skills, would trigger patients’ higher levels of emotional cues.
The communication skills and sequence process between nurses and simulated cancer patients were validated. Enhancing nurses competence and confidence to deal with cancer patient’s emotion are crucial. The cancer communication education program will be designed for future oncology training protocol based on the key predictors reported in the current study. To foster the nurse–patient relationship and quality of nursing care through facilitating nurses’ communication skills will be highly expected.

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