台灣區域醫院以上護理個案管理師之工作現況 及其工作特性、工作壓力與工作承諾關係之探討

The Current Work Conditions and Relationships among Job Characteristics、Job Strain and Job Commitment in Taiwan’s Regional Hospital Nurse Case Managers

鍾佳玲(Chia-Ling Chung)

指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.03100

摘要

管理性照護在國內方興未艾，醫療保健環境的快速變化不僅使得體制改變，體制內的工作人員角色也跟著牽動變化，因此本研究以新興的護理個案管理師作為研究對象，進行工作現況調查，並嘗試瞭解護理個案管理師的工作特性、工作壓力及工作承諾，以及三者間的關係。
本研究以全台灣區域醫院以上，所有不同疾病的護理個案管理師為樣本，共發出177份問卷，回收有效問卷143份，有效回收率80.79 %，研究工具採結構式及辦結構式問卷，以郵寄問卷法收集資料。研究重要發現：一、護理個案管理師的個人屬性為1.女性為主、2.年齡以31~35最多(40.7 %)、3.護理教育背景以專科以下為多(52.5 %)、4.總護理年資以≧6年為最多(88.6 %)、5.擔任護理個案管理師之年資以1~2年為最多(50.7 %)、6.擔任身份已有身兼他職佔最多(53.9%) ; 工作現況為：1.稱呼不一、2.管理部門多重、3.護理個案管理的教職教育施行偏低4.臨床路徑使用率低5.成效評量以病患滿意度為最多; 工作內容以1.接受病患諮詢、2.病患/家屬治療溝通協調、3.病患衛生教育最多。二、以ANOVA及t檢定進行變項間在工作承諾上的差異分析 ; 護理個案管理師的個人屬性以1.不同的年齡、2.婚姻狀態、3.護理教育背景及4.護理專業進階在工作承諾上有差異 ; 工作現況以1.目前共有個案量、2.是否使用其他機構提供的個案管理工具、3.醫院評鑑等級、4.護理個案管理之所屬階段及5.護理個案管理成效評估之頻率在工作承諾上有差異 。三、護理個案管理工作的五項工作特性屬中上程度，其工作激勵潛能指數 ( MPS ) 高於一般護理人員 ; 其工作壓力之負荷-控制交叉分類以低工作壓力族群為多，並且主動型職業族群較一般護理人員多。四、線性迴歸得護理個案管理工作的MPS與工作承諾呈正相關 ; 羅吉斯迴歸得MPS與工作壓力呈負相關 ; 工作壓力對MPS與工作承諾的影響不具中介效果。研究建議：1.確立護理個案管理師定位2.加強在職教育訓練3.增加成效評量多樣性4.發展臨床路徑。

關鍵字

護理個案管理師 ； 護理個案管理 ； 工作特性 ； 激勵潛能指數 ； 工作壓力 ； 工作承諾

並列摘要

With the arising managed care environment, the rapid changes in healthcare reform does not only affect the structure, it also affect the staffs’ role play within it. Hence we took the developing nurse case managers as our study subject, and survey their work conditions. We gathered the positive and negative factors of nurse case manegement by means of analyzing their perceptions on job characteristics、job strain and job commitment, further we discuss the relationship among nurse case managers’ perception within the three.
Our sample is mainly included all nurse case managers in different practice or settings in Taiwan’s regional hospitals and above. We issued 177 questionnaires and received 143 effective copies . The response rate is 80.79 %. The data collection is by paper instrument combined structured and semi-structured questionnaire .
Our findings are : 1. The profiles of Taiwan’s regional hospital nurse case managers : (1) no male nurse case managers during data collection time, (2 ) most are aged 31 to 35 (40.7%), (3 ) most are under junior college educated ( 52.5%), (4 ) most has 6 or more years of nursing careers (88.6%), (5 ) most are experienced 1 to 2 years of case management practice (50.7%), and (6 ) most has two more duties of job (53.9%). The work conditions are : (1 )titles vary, ( 2 )face with multiple administrations, (3 ) seldom receive on-job training, (4) lack of clinical pathways , and (5) outcomes are mostly evaluated with patient satisfaction. And the most ranked job descriptions are (1 ) consultant to patients, (2 )communicate with patients/family and (4) patient education.
2. Using ANOVA and t-test for variance analysis. For job commitment, the nurse case managers’ personal attributes varies significantly in ( 1 ) age, (2 ) marital status, (3 ) nursing education background, and (5 ) clinical ladders. And work conditions varies significantly for job commitment are : (1) case load, (2 ) whether use nurse NCM instrument provided by other institutions, (3 ) hospital accreditation level, (4 ) nurse case management status and (5 ) frequency of NCM outcome evaluation.
3. The five core job characteristics in NCMs are of middle-high level, the Motivation potential score (MPS ) is higher than that of staff nurse. Most of their demand-control job strain classification are in low strain and active job , and the job commitment are higher than that of staff nurse.
4. Linear regression found that：the MPS was correlated with job commitment, whereas Logistic regression reveals the MPS was negatively correlated with Demand-Control job strain, and D-C job strain has no mediation effect between job characteristics and job commitment. Conclusions suggest : (1) ensure NCM job position, (2) enhance on-job training, (3) increase the diversity of outcome evaluation, (4) deploy clinical pathways .

並列關鍵字

Nurse Case Manager ； Nursing Case Management ； job characteristics ； motivation potential score ( MPS ) ； job strain ； job commitment.

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