醫院護理人員特性、組織特性、工作環境感受及護理敏感病人照護結果指標之相關性研究

近年來由於護理人力短缺、人力配置不當，以致護理人員工作負荷過重、工作意願低落及工作表現不佳，甚而影響病人安全，故本研究目的為探討醫院護理人員特性、組織特性、工作環境感受與護理敏感病人照護結果指標的關係。本研究為橫斷性相關性研究，於北部某醫學中心收集17個內、外、婦產、兒科病房及5個加護病房中之次級資料與以問卷調查617位護理人員。資料分析採百分比、平均值、標準差、t檢定、ANOVA、Spearman相關係數及多元線性迴歸分析。本研究結果顯示護理人員對目前護理工作環境的整體感受為中等程度滿意(M = 3.01)。加護病房護理人員在「以護理為基礎的照護品質」感受最佳（M = 3.04），而一般病房則對「護理領導能力、方式與對護理人員的支持力」感受最佳（M = 3.14），但不論加護病房或一般病房，護理人員對「足夠的護理人力」感受最差（M = 2.79；2.75）。護理人員對工作環境感受受到年齡（F = 20.763, p < .001）、工作年資（F = 16.896, p < .001）、婚姻狀況（t = 2.184, p < .05）、病房種類（t = - 2.958, p < .01）、護理專業能力進階層級（F = 11.142, p < .001）、離職意向（F = 15.368, p < .001）的影響而呈現統計上之顯著差異。另外，護理人員對工作環境感受也受到工作時數及住院天數之影響而有顯著差異（F = 7.948, p < .01；F = 4.936, p < .001）。研究結果也發現跌倒、壓瘡、泌尿道感染及呼吸道感染在加護病房與一般病房有統計上的顯著差異（t = - 25.431, p < .001；t = 17.404, p < .001; t = 20.209, p < .001；t = 15.362, p < .001）。病護比、佔床率、住院天數及護理人員每月工作時數與跌倒呈正相關（r = .141, p = .007；r = .141, p < .001；r = .278, p < .001；r = .356, p = .011）。加護病房病護比、佔床率、護理人員工作時數與壓瘡呈正相關（r = .599, p < .001；r = .823, p < .001；r = .263, p < .001），而一般病房病護比、佔床率、住院天數與壓瘡呈正相關（r = .511, p < .001；r = .715, p < .001；r = .229, p < .001），但加護病房及一般病房之護理時數與壓瘡呈負相關（r = - .443, p < .001；r = - .541, p < .001）。另外，加護病房病護比、佔床率及護理人員每月工作時數與泌尿道感染呈正相關（r = .831, p < .001；r =.107, p < .001；r = .697, p < .001），一般病房病護比、佔床率、病人住院天數、護理人員每月工作時數與泌尿道感染呈正相關（r = .650, p < .001；r = .690, p < .001；r = .286, p < .001；r = .531, p < .001）。加護病房病護比、佔床率、住院天數及護理人員每月工作時數與呼吸道感染呈正相關（r = .452, p < .001；r = .259, p < .001；r = .370, p < .001；r = .709, p < .001），一般病房之病護比、住院天數及護理人員每月工作時數與呼吸道感染呈正相關（r = .429, p < .001；r = .624, p < .001；r = .313, p < .001），而加護病房及一般病房之護理時數則皆與呼吸道感染呈負相關（r = - .386, p < .001；r = - .668, p < .001）。護理人員工作環境感受與離職意向呈顯著負相關（r = - .294, p < .001）。多元迴歸分析顯示性別及佔床率是影響護理人員對護理工作環境感受的重要預測因子（F = 9.771, p< .001），可解釋之總變異量為13.7%。本研究結果將可作為醫療主管機關及護理主管之參考，發展策略，改善護理人員對工作環境之感受，進而提升醫療照護品質。

關鍵字

護理人員特性；組織特性；工作環境感受；護理敏感病人照護結果指標

並列摘要

In recent years, nursing shortage and improper staffing have resulted in nurses’ work overload, unwilling to work, poor job performance, and even affected patient safety. Therefore, the aim of this study was to investigate the correlations between personal characteristics, organizational characteristics, work environment perceptions, and nursing-sensitive patient outcomes among hospital nurses. A cross-sectional correlation study was conducted at a medical center in northern Taiwan to collect existing data from 17 medical, surgical, obstetric and gynecologic, and pediatric wards, 5 intensive care units (ICUs) and to survey 617 clinical nurses. Data were analyzed using percentage, mean, standard deviation, t-test, ANOVA, Spearman correlation, and multiple linear regressions. Results found that nurses felt moderate satisfied with the current work environment (M = 3.01). Of these, nurses in the ICUs felt most satisfied with the "nursing foundations for quality of care" (M = 3.04), while the nurses in the general wards felt most satisfied with "nurse manager ability, leadership" (M= 3.14). However, regardless nurses in the ICUs or general wards, they felt most dissatisfied with “resource adequacy" (M = 2.79; 2.75). The results also revealed that the work environment was affected by nurses’ age (F = 20.763, p <.001), work experience (F = 16.896, p <.001), marital status (t = 2.184, p <.05), ward types (t = -2.958, p <.01), professional competency level in the clinical ladder (F = 11.142, p <.001), turnover intention (F = 15.368, p <.001). Besides, the work environment was also affected by nurses’ working hours and patients’ length of hospital stay (F = 7.948, p <.01; F = 4.936, p <.001, respectively). There were significant differences between ICUs and general wards in falls, pressure sores, urinary tract infection, and respiratory infection (t = -25.431, p <.001; t = 17.404, p <. 001; t = 20.209, p <.001; t = 15.362, p <.001, respectively). Significant positive correlations were found between patient-nurse ratio in three shifts, occupancy rate, length of hospital stay, and nurses’ working hours, and falls (r = .141, p = .007；r = .141, p < .001；r = .278, p < .001；r = .356, p = .011, respectively). Significant positive correlations were also found between patient-nurse ratio, occupancy rate, nurses’ working hours, and pressure ulcers in the ICUs (r = .599, p < .001；r = .823, p < .001；r = .263, p < .001, respectively). Significant positive correlations were also found between patient-nurse ratio in three shifts, occupancy rate, length of hospital stay, and pressure ulcers in general wards (r = .511, p < .001；r = .715, p < .001；r = .229, p < .001, respectively). However, there was a significant negative correlation found between nurses’ nursing care hours and pressure ulcers in the ICUs and general wards (r = - .443, p < .001；r = - .541, p < .001, respectively). Significant positive correlations were found between patient-nurse ratio, occupancy rate, working hours, and urinary tract infection in the ICUs (r = .831, p < .001；r =.107, p < .001；r = .697, p < .001, respectively). Significant positive correlations were found between patient-nurse ratio in three shifts, occupancy rate, length of hospital stay, nurses’ working hours, and urinary tract infection in general wards (r = .650, p < .001；r = .690, p < .001；r = .286, p < .001；r = .531, p < .001, respectively). Significant positive correlations were found between patient-nurse ratio in three shifts, occupancy rate, length of hospital stay, nurses’ working hours, and respiratory infection in the ICUs (r = .452, p < .001；r = .259, p < .001；r = .370, p < .001；r = .709, p < .001, respectively). Significant positive correlations were found between patient-nurse ratio in three shifts, length of hospital stay, nurses’ working hours, and respiratory infection in general wards (r = .429, p < .001；r = .624, p < .001；r = .313, p < .001). Nurses’ nursing care hours and were negatively correlated with respiratory tract infection in the ICUs and general wards (r = - .386, p < .001；r = - .668, p < .001, respectively). Multiple linear regression analyses demonstrated that gender and occupancy rate significantly predicted nurses’ perceived work environment (F = 9.771, p< .001).Those factors accounted for 13.7% of the total variance.The findings can be used as references for hospital and nursing leaders to develop strategies to improve nurses’ perceptions of work environment, and thus enhance the quality of care.

並列關鍵字

personal characteristics ； Organizational Characteristics ； Work Environment Perceptions ； Nursing-sensitive Patient Outcomes

參考文獻

Chang, Y. K., & Mark, B. A. (2009). Antecedents of severe and nonsevere medication errors. Journal of Nursing Scholarship, 41(1), 70-78. doi: 10.1111/j.1547-5069.2009.01253.x

中文文獻