新制醫院評鑑與護理品質管理

The New Hospital Accreditation and Nursing Quality Management

尹裕君(Yu-Chun Yin)

《榮總護理》 22卷2期 (2005/06) Pp. 109-116

https://doi.org/10.6142/VGHN.22.2.109

摘要

本文旨在討論新制醫院評鑑改變與護理品質管理，首先描述國內外醫院評鑑之發展，我國是全世界第四，亞洲第一個實施醫院評鑑的國家。新制醫院評鑑目前分爲醫學中心與社區醫院之評鑑。改革之重點是建立以病人爲中心的評鑑制度、結構面轉變爲過程面及結果面，其核心價值是「顧客；社區；貢獻」，建立安全、有效、以病人爲中心、適時、效率、公正優質的評鑑機制。新制醫院評鑑對護理品質提升之方向包括一、加重在過程與結果品質，但未忽視結構品質。二、由病人之感受方面來訂定指標。三、指標亦考量護理人員之感受與福利。四、指標加強在護理管理。五、指標強調病人安全及感染管制。六、指標強化持續性照護及長照護理之重要。護理界對護理品質所面臨之困境筆者認爲包括一、基層護理人力之不穩定造成資深及管理階層之疲憊不堪。二、由於缺乏留才策略，因此護理人事資源管理亦無法做好擇才及育才，而成爲護理品質管理之隱憂。三、新制醫院評鑑之改革造成護理主管更重之負荷。結論是護理界應以實證基礎建立護理照護品質管理的資料，應用於護理成本、護理人力資源及護理照護系統作合理的管理，專業團體則應用社會與政治力量來改善護理環境。

關鍵字

醫院評鑑 ； 護理品質管理

並列摘要

The purpose of this article is to discuss how the new hospital accreditation standards will effect nursing quality management. From the history of hospital accreditation aspect, our country is the fourth in the world and the first in Asia to have implemented hospital accreditation. The new hospital accreditation is divided into medical centers and community hospitals. The new standards focus on patient-centered care, and change the structure indicators into the process and outcome indicators. The core values are customer, community and contribution. The accreditation mechanism is established to promote safety, effectiveness, patient-centered care, efficiency and justice in health care. The new hospital accreditation standards should improve nursing quality by: 1.emphasizing process and outcome while not neglecting structure; 2.establishing indicators from the patients perception; 3.considering the nurses perception; 4.increasing nursing management; 5.strengthening patients' safety and infection control indicators; 6.enhancing the importance of continuing nursing and long-term care. The difficulties in improving nursing quality are: 1.burn- out of managers and experienced nurses, which results from the undependability of new nurses; 2.the lack of a strategy to keep nurses in the workplace; 3.the new hospital accreditation standards are increasing the nurses manager's workload. Conclusion: nurses should establish evidence-based quality management data concerning cost, manpower, and management, then linking social and political forces in order to improve the nursing environment.

並列關鍵字

accreditation ； mechanisms ； perception ； enhancing ； environment