急診室病人就醫安全態度與就醫安全參與行為量表發展與測試之前驅研究

A Pilot Study on Development, Psychometric Testing of Safety Attitude and Safety Participation in Emergency Department

郭文福(Wen-Fu Kuo)

指導教授 ： 林淑媛

高雄醫學大學/護理學院/護理學系碩士班/碩士(2017年)

摘要

急診室是提供醫療服務重要窗口，但對於急診室就醫病人的安全態度與就醫安全參與行為，卻少有測量工具及調查作探討，故本研究目的為發展及測試「急診室病人就醫安全態度量表」與「急診室病人就醫安全參與行為量表」之信效度，並了解急診室病人在就醫安全態度與就醫安全參與行為的現況。
本研究採橫斷式研究設計，針對南部某醫學中心134名急診就醫病人，以自擬量表進行資料收集，使用SPSS18.0進行資料分析。量表效度以主軸因素分析進行檢定，信度分析以Cronbach’s α值計算內在一致性，並以Pearson相關係數檢定題項、次量表與量表之相關性，描述性統計包括人口學特性及急診就醫屬性，推論性統計則以t檢定比較急診室就醫病人人口學及就醫屬性在就醫安全態度及就醫安全參與行為之差異。
「急診室病人就醫安全態度量表」為16題，共萃取出三個因子，命名為「就醫安全認知」、「就醫安全感受與溝通」、「病人及治療確認」，總解釋變異量為63.95%，Cronbach’s α係數為.91；「急診室病人就醫安全參與行為量表」為12題，共萃取出兩個因子，命名為「照護參與行為」、「照護溝通行為」，總解釋變異量為46.31%， Cronbach’s α係數為.87。
研究樣本以女性為主(50.7%)，平均年齡為40.96歲，檢傷級數以三級為主(62.7%)，診療後動向以收住一般病房為主。研究樣本在就醫安全態度趨正向且就醫安全參與行為程度高，而年齡、教育程度、職業、婚姻狀態與診治後動向在就醫安全態度有顯著差異，這些變項在就醫安全參與行為則無差異。
「急診室病人就醫安全態度量表」和「急診室病人就醫安全參與行為量表」均具良好信效度，可做為了解急診室病人在就醫安全態度及就醫安全參與行為的施測工具，未來可應用此兩種量表在不同地區急診室及醫院住院單位，讓病人安全調查可更周全，未來更可納入病人意見之質性研究來增修題目，以提高問卷內容因素分析之總變異量，建議政府機關可持續宣導民眾參與對提升照護安全的重要性，並教育醫療人員正向看待病人安全參與，以提升整體就醫安全風氣。

關鍵字

就醫安全態度 ； 就醫安全參與行為 ； 量表測試

並列摘要

The Emergency Department (ED) plays a critical role in the provision of medical services; however, investigations into the methods of assessment instruments and on surveys regarding the following topics are scant: ED patients’ attitudes toward medical treatment safety and their participation behaviors. Therefore, the research objectives in this study were to develop and test the reliability and validity of two scales: “Scale on ED Patients' Attitudes toward Medical Treatment Safety” and “Scale on ED Patients' Participation Behaviors Related to Medical Treatment Safety.” This study also aimed to determine the current conditions of ED patients in terms of their attitudes toward medical treatment safety and their participation behaviors.
We conducted a cross-sectional research design and recruited 134 patients who received medical treatments from the ED at a medical center in Southern Taiwan. Data were collected based on a self-designed scale, and were analyzed using SPSS18.0. Principal axis factoring was adopted to test the validity of the scales, and Cronbach’s α value was employed to calculate the internal consistency of the reliability analysis. We adopted Pearson's correlation coefficients to examine the associations among the items, sub-scales, and scales. The descriptive statistics contained demographic characteristics and emergency medicine attributes. Regarding the inferential statistics, a t-test was conducted to compare the differences between ED patients’ attitudes toward medical treatment safety and participation behaviors on the basis of demographics and medical treatment attributes.
The “Scale on ED Patients' Attitudes toward Medical Treatment Safety” contained 16 items, among which three factors were extracted and named as “cognition of medical treatment safety”, “perceptions toward medical treatment safety and communication” and “patients and treatment confirmation.” The total variance explained was 63.95% and Cronbach’s α coefficient was .91. A total of 12 items were included in “Scale on ED Patients' Participation Behaviors Related to Medical Treatment Safety,” among which two factors were extracted and named as "participation behavior in caring" and "communication behavior in caring." The total variance explained was 46.31% and Cronbach’s α coefficient was .87.
The research samples mainly involved female patients (50.7%) with an average age of 40.96 years, most of whom were in level 3 triage (62.7%). The patients were transferred to general wards after receiving treatment in the ED. A positive tendency, in terms of patients' attitudes toward medical treatment safety, was observed from the research results, with the patients also exhibiting a high level of participation behavior related to medical treatment safety. When the following variables: age, educational attainment, occupation, marital status, and medical treatment results were included, a significant difference was observed in patients' attitudes toward medical treatment safety, but no significant difference was observed in their participation behaviors related to medical treatment safety.
Favorable reliability and validity resulted from both the “Scale on ED Patients' Attitudes toward Medical Treatment Safety” and “Scale on ED Patients' Participation Behaviors Related to Medical Treatment Safety.” These two scales can serve as the assessment instruments for determining emergency patients' attitudes toward medical treatment safety and participation behaviors. In the future, these two scales can be applied to EDs and inpatient units at hospitals in different locations, with an aim to conduct comprehensive surveys on patient safety; in addition, qualitative research can be further conducted and items such as patients' options can be added or modified, thereby elevating the total variance of the questionnaire’s factor analysis. We recommend that government agencies continue to promote the importance of how patient participation can elevate the safety of medical care, as well as to educate medical personnel to positively view patients' participation in relation to medical treatment safety, thereby elevating the overall safety of medical treatment.

並列關鍵字

patients’ safety attitude ； patients’ safety participation ； instrument testing

參考文獻

中文部分

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