急診病患對以病人爲中心的照護感受之分析

Study of Emergency Patients' Perceptions of Patient-Centered Care

王發財(Fa-Tsai Wang) ； 溫麗芬(Li-Fen Wen) ； 葉明珍(Ming-Chen Yeh) ； 張彩秀(Tsai-Hsiu Chang)

《Journal of Emergency Medicine, Taiwan》 11卷4_S期 (2009/12) Pp. s20-s26

摘要

背景：急診是提供病患緊急照護的場所，病患的感受是緊急醫療服務品質良窈的重要指標。本研究擬探討急診病患對醫院所提供「以病人為中心」之照護感受，並分析影響急診病患「以病人為中心」照護感受之相關因素。
方法：研究針對台中縣某區域教學醫院急診病患進行「以病人為中心」照護感受（包括滿意度、參與程度、資訊分享與關懷四項）與醫病關係信念之橫斷面調查，採立意取樣，資料收集期間為97年6月20日至97年8月30日，以有效的結構問卷(Content Validity Index=85~100%，Cronbach's α=0.895-0.950)，進行病患人口學特質、醫病關係信念與「以病人為中心」照護感受之資料收集，得有效樣本共307名。
結果：整體以病人為中心的照護感受的總平均值為3.77±0.59（最高分數為5分），標準化百分率75.4%，屬中上程度正向之感受。「醫病關係信念」能顯著預測以病人為中心之照護感受，可解釋變異量為77.1%。
結論：急診病患以病人為中心之照護感受屬中上程度正向。另外，醫病關係信念是預測以病人為中心照護最主要因素。在強調以病人為中心的醫療服務趨勢下，未來可透過醫療人員在職教育，加強專業知能，有系統的訓練醫療人員在人際關係方面的溝通技巧、民主化的醫病關係、維護病人的隱私權、加強醫師與病患的互相體諒瞭解、及改善病患就醫環境與其醫療政策等促進醫病關係的方法，來增進急診室醫療人員對待處理病患之技能，促進病患對醫病關係信念之感受，進而達成以病患為中心之照護目標。

關鍵字

急診 ； 病人為中心 ； 滿意度 ； 醫病關係信念

並列摘要

Background: The emergency room provides services for patients with urgent conditions. Patients' perceptions are an important indicator of the quality of medical services. The purpose of this study describes patients' perceptions of patient-centered care in the emergency room of a regional hospital in central Taiwan, and analyzes factors related to these perceptions.
Methods: A cross sectional survey and purpose sampling were conducted and 307 subjects were recruited (during 20 June 2008 to 30 August 2008). A valid structured questionnaire was used (Content Validity Index was 80%-100%, and Cronbach's α was 0.895-0.950). The contents of the questionnaire included patient characteristics, health status, beliefs about the doctor-patient relationship and perceptions of patient-centered care, including satisfaction, involvement, information sharing and caring.
Results: The mean score of perceptions of patient-centered care was 3.77±0.590 (highest possible score was 5 points), and the standard percentage was 75.4%. This means that patients' perceptions of patient-centered care were moderately positive. The most important predictor of perceptions of patient-centered care was beliefs about the doctor-patient relationship (R^2=77.1%).
Conclusions: Patients' perceptions of patient-centered care in the emergency room were moderately positive. Furthermore, beliefs about the doctor-patient relationship were an important factor in perceptions of patient-center care. In stressing patient-centered medical services, we should emphasize educational in-services to improve professional capability, systematic training of health care workers, improvement of interpersonal communication skills and democratization of the doctor-patient relationship. We also need to maintain patient privacy, strengthen mutual consideration and understanding between physicians and patients, and improve the treatment environment of patients to promote the doctor-patient relationship. These actions can promote physician skills and satisfy patient beliefs about the doctor-patient relationship to meet the main goal of patient centered care.

並列關鍵字

emergency department ； belief of doctor-patient relationship ； patient-center care ； satisfaction