一個產科健康照顧模式之初探

The Development and Evaluation of an Obstetric Health Care Delivery Model:A Preliminary Study

鍾聿琳(U. L. Chung) ； 黃俊喨(C. L. Hung) ； 劉達麗(T. L. Liu) ； 洪麗嬌(L. C. Hung) ； 吳玲娟(L. J. Wu)

《護理雜誌》 45卷4期 (1998/08) Pp. 33-49

https://doi.org/10.6224/JN.45.4.33

摘要

本研究之目的有二，(一)建立一個新的産科健康照顧模式。此模式包含兩個重點：(1)由助産護理師及産科醫師共同管理産婦之生産(midwife-obstetrician co-managed service)，(2)LDR(labor/delivery/recovery)program-即是産婦待産、生産、産後恢復及照顧均安排在同一個房間，且由相同之助産護理人員來照顧。(二)評量此健康照顧模式之效益，效益之指標爲：(1)剖腹生産之機率，(2)生産醫療費用，(3)顧客滿意度。在建立新産科健康照顧模式方面，主要是參考國內外資料幷利用樣本醫院中的資源，在評量方面則採二組對照比較方式進行。170們符合選樣條件的孕産婦，以自選方式納入傳統産科健康照顧組(151人)或新産科健康照顧組(19)人，再由151人中就新産科組19位樣本之基本資料配對，配對後的二組(各19人)再進行依變項之比較，以避免因二組樣本特質差異影響研究結果。研究工具主要是研究者自擬之顧客滿意度問卷及作業流程成本分析調查表。研究結果顯示配對後之二組産婦對所提供之産科健康照顧均頗滿意且滿意度類似，在剖腹産機率方面，二組均未有剖腹産者。唯在生産的花費上，傳統組明顯高於新産科組。故本研究建議樣本醫院應繼續提供此二種生産健康照顧模式，給予顧客多一種選擇之機會，同時應努力增加新産科健康照顧組之樣本數，以提升本研究之公信度。

關鍵字

助產護理師 ； 單一產科照護體系 ； 評量 ； 剖腹產率 ； 顧客滿意度

並列摘要

The purposes of the study were (1) to establish a new obstetric service model characterized by Nurse-midwife attended births and a labor delivery recovery (LDR) program in the hospital; (2) to evaluate this new service model by comparing it with the existing obstetric service model of traditional obstetrician attended births, in terms of cesarean rate, clients' satisfaction with the service and care cost. A two-group comparison design is used. Nineteen pairs of women matched as closely as possible in terms of demographic differences were used for comparison. A client satisfaction questionnaire, a cost calculation sheet and a c/s record were utilized for data collection. Chi-Square, t-test and 95% confidence interval were employed for statistical analysis. Results reflected that clients of both services were equally satisfied with quality of care, There were no c-sections in either group. However, the cost of the traditional service was significantly higher than that of the new service model. Discussions of the limitations of the study and recommendations are included.

並列關鍵字

nurse-midwife attended births ； LDR program ； evaluation ； cesarean section rate ； clients' s atisfaction