醫療工作人員的病人安全認知、態度與行為間關係之探討-以臺北某醫院為例

An Exploratory Study of the Relationship between Healthcare Workers’ Knowledge, Attitude and Behavior in a Taipei Hospital

何清幼(Chin-Yu Ho)

指導教授 ： 鍾國彪

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.00446

摘要

背景與目的：「提升病人安全」已成為各國醫療體系越來越重視的議題。但目前已發表的文獻對病人安全認知、態度與行為表現的相關性研究仍然不足。故本研究欲探討醫療工作人員之個人與工作特質如何影響其對病人安全的認知、態度與行為表現；瞭解醫療工作人員的病人安全態度，及其對國家病人安全目標的認知與行為三者間之關係。希望能將結果回饋給研究醫院，協助找出病人安全之關鍵影響因素，據以進行重點改善與突破，以提升病人安全與醫療品質。
研究方法：本研究為橫斷式研究，研究對象為臺北某醫院之醫療工作人員3904人，以普查不記名方式進行施測，收案期間為2010年3月16日至同年4月15日。病人安全認知與行為量表由筆者自行設計，病人安全態度量表應用Dr. Bryan Sexton 授權醫策會翻譯為中文的安全態度問卷(Safety Attitudes Questionnaire, SAQ)。以描述性分析、獨立樣本T檢定、單因子變異數分析、斯皮爾曼等級相關及複迴歸方法分析資料。
研究結果：有效樣本回收率為56.99%（2225/3904）。男性、教育程度較高、擔任主管者有較高的病人安全認知，且醫師高於護理及醫事人員。教育程度較低、年齡較長、病房助理、醫院年資較深、擔任主管者有較正向的病人安全態度。女性、醫院年資較深、擔任主管、直接接觸病人者有較佳的病人安全行為表現，此外醫師與護理人員之病人安全行為較醫事人員佳。相關分析結果：病人安全的認知愈高，病人安全的態度愈正向，病人安全的行為表現也愈佳。複迴歸分析結果：「異常事件通報」認知構面為病人安全態度每個構面的重要影響因子。「感染控制」、「異常事件通報」、「團隊溝通」認知構面是病人安全行為每個構面的重要影響因子。「溝通學習」、「工作狀況」態度構面是病人安全行為每個構面的重要影響因子，且「溝通學習」態度構面的影響力均較其他態度構面大。態度構面對病人安全行為的影響較認知構面大。

結論：病人安全之認知與態度成正相關；病人安全之認知與行為表現成正相關；病人安全之態度與行為表現成正相關；病人安全之認知、態度與行為表現成正相關。「異常事件通報」與「溝通學習」是病人安全的關鍵影響因素，相關單位應把「鼓勵異常事件通報」及「提升醫療照護人員間溝通的有效性」列為推動病人安全的優先目標與策略。

關鍵字

病人安全認知 ； 病人安全態度 ； 病人安全行為 ； 病人安全目標 ； 問卷

並列摘要

Background and purposes：The healthcare systems of many countries try hard to improve patient safety. However, the existed studies about the knowledge, attitude, and behavior about patient safety are not comprehensive. The purposes of this study are to investigate how the personal and occupational characteristics of different healthcare workers can influence their knowledge, attitude, and behavior about patient safety; and to explore the relationship between their attitude, knowledge and behavior toward the national patient safety goal. The author wants to find the key factors to improve the most critical issues to improve the patient safety and the quality of healthcare systems.
Method：This cross-sectional study generally and anonymously surveyed 3904 healthcare workers of a Taipei Hospital from March 16th to April 15th, 2010. The questionnaires about patient safety knowledge and behavior were designed by the author. The questionnaires about patient safety attitude were derived from the Chinese version of Safety Attitudes Questionnaire, authorized by Dr. Bryan Sexton to the Taiwan Joint Commission on Hospital Accreditation and Quality Improvement. The author used descriptive analysis, independent-sample T test, one-way ANOVA, Spearman rank correlation, and multiple regression analysis to examine the collected data.
Results：The overall response rate was 56.99%（2,225 out of 3904 questionnaires）. Males, high-educated healthcare workers, administration managers, and doctors have more patient safety knowledge. Low-educated, older or senior healthcare workers, nursing assistants, and administration managers have more positive patient safety attitude. Females, senior healthcare workers, administration managers, and the first-line people have better patient safety behavior. The doctors and nurses behave better than the technicians. The author finds that there are positive correlations between patient safety knowledge, attitude, and behaviors. Multiple regression analysis revealed “incident reporting” of the knowledge domain is important and influential factor of every attitude domain. “Reducing infection”, “incident reporting”, and “team communication” of the knowledge domain are the important and influential factors of every behavior domain. “Communication and learning” and “working conditions” of the attitude domain are the important factors of every behavior domain, and “communication and learning” is the most influential factor. The attitude domains influence behavior more than the knowledge domains.
Conclusion：There are positive correlations between patient safety knowledge and attitude, patient safety knowledge and behavior, patient safety attitude and behavior, and patient safety knowledge, attitude and behavior. The “incident reporting” and . “Communication and learning” are critical factors to patient safety. The healthcare policy-makers should give priority to “encourage incident reporting” and “improve the effectiveness of communication among caregivers” to further patient safety.

並列關鍵字

patient safety knowledge ； patient safety attitude ； patient safety behavior ； patient safety goal ； questionnaire

參考文獻

石崇良（2009）。政府推動病人安全之成果與展望。醫療品質雜誌，3（2）：9-12。

余錦美（2007）。病人安全文化初探-以臺北市某醫院為例。未發表碩士論文。台北。台北醫學大學。

吳萬益、郭幸萍、彭奕龍（2002）。醫學中心組織文化、管理模式、競爭優勢與經營績效之互動相關影響研究。醫務管理期刊，3：17-35。

吳麗蘭（2008）。醫院員工對病人安全之認知與態度調查。北市醫學雜誌，5：75-85。

李偉強、簡淑芬、陳玉枝（2008）。中文版病人安全態度問卷信效度分析。台灣衛誌， 27：214-222。