單位照顧與傳統式機構照護模式品質比較研究

Comparison of Quality of Care in Special Care Unit and Traditional Nursing Home Settings

黃春宜(Chun-i Huang)

指導教授 ： 王劼

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2015年)

https://doi.org/10.6833/CJCU.2015.00038

摘要

背景與目的:
台灣地區因醫療衛生進步，老年人口和比例呈現顯著成長及高齡化社會帶來的衝擊，老人長期照護需求也急遽增加。台灣開始推展小型機構照護，但其照護品質是否相對於一般傳統式照護有較好，目前鮮有研究深入探討。本研究目的在探討「單位照顧」相對於「傳統式照護」機構照護模式在老人之日常生活活動功能及身體質量指數之照護品質結果是否有差異。
研究方法:
本研究採用雙組前後測準實驗設計，研究對象為2009年1月1日至2013年12月31日期間入住兩家機構達一年以上之老人。實驗組為居住於南部地區一採用單位照顧服務；對照組為居住於同地區一採用傳統式照護服務之養護中心老人。
本研究共進行二次配對，第一次配對採性別及日常生活活動功能配對；第二次配對採年齡及日常生活活動功能配對。個案資料運用SPSS 18.0之統計軟體進行資料分析，資料分析方法分成描述性統計、t-檢定、卡方檢定、Signed Ranks Test及Mann-Whitney U檢定法等統計方法進行資料處理。
研究結果:
本研究共進行二次配對分析，結果發現在第一次配對以性別與日常生活活動功能配對時，實驗組使用單位照顧模式的住民，一年後日常生活活動功能較入住時統計上有顯著改善，對照組則無。在身體質量指數方面，二次配對都顯示實驗組在二次配對前後測之間稍有改善而對照組則略降，但未達顯著差異。進一步分析比較兩家機構在入住時與一年後在日常生活活動功能及身體質量指數照護品質之變化情形，結果發現實驗組與對照組間統計上無顯著差異。
結論:
目前沒有嚴謹的研究顯示單位照顧有較好的照護品質療效，建議未來可考慮以前瞻式研究比較單位照顧與傳統式機構照護品質在認知功能及生活品質上之療效，提供長期照護機構在照護品質提昇實務之參考。

關鍵詞: 單位照顧、長期照護機構、照護模式、品質成效、長期照護

關鍵字

單位照顧 ； 長期照護機構 ； 照護模式 ； 品質成效 ； 長期照護

並列摘要

Background and Objectives:
In recent years, smaller nursing home has been promoted to improve quality of care and quality of life for institutionalized older people. However, to date, there are very few studies that specifically compared smaller nursing homes with traditional nursing homes. This study compared the quality of care between a smaller special care unit nursing home (unit care nursing home) and a larger traditional nursing home on activities of daily living (ADLs) and body mass index (BMI).

Method:
This is a quasi-experimental pretest and posttest design study. Participants who have lived in nursing homes for at least one year were recruited from two different nursing homes, one is a “unit care” nursing home and the other is a larger traditional nursing home in the same area. To reduce the possibility of selection bias, we created two series of matched samples to conduct the analyses. In the first matched sample, gender and ADLs were chosen as the matching variables. In the second matched sample, age and ADLs were chosen as the matching variables. The first matched sample contained 64 participants and the second matched sample contained 56 participants. T-tests, Chi-square tests, Signed Ranks Tests and Mann-Whitney U tests were used for analyses.

Result:
In the first matched sample, participants in the experimental group had significant improvement of ADLs after living in the special care unit nursing home for one year. There was no significant improvement in ADLs for the control group. There was no significant improvement in BMI in either experimental or control groups. In the second matched sample, there was no significant improvement in ADLs and BMI for both the experimental and control groups. Mann-Whitney U tests showed that there was no significant difference in quality of care between unit care nursing home and traditional nursing home, as measured by ADLs and BMI.

Conclusion:
Additional studies are required to elucidate the efficacy of smaller nursing homes. Quality of life and cognitive impairment may be better choice as outcome variables in future studies.

Key Word: Special care unit, unit care, long-term care, quality of care, activities of daily living

並列關鍵字

Special care unit ； unit care ； long-term care ； quality of care ； activities of daily living

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