護理人員對醫院異常事件通報的認知與執行之探討—以北部某市立聯合醫院為例

To Explore The Cognition and Reporting of Hospital Incident for Nurses ---A Case of Taipei City Hospital

張美鈴(Mei-Ling Chang)

指導教授 ： 林秋芬

臺北醫學大學/護理學院/護理學系碩士暨碩士在職專班/碩士(2012年)

摘要

近年來因臨床發生幾件重大醫療疏忽事件，也造成不少人傷亡，護理人員在醫療團隊中為病人臨床照護的主要人力，更關乎病人安全最重要的成員，所以本研究旨在了解護理人員對醫院異常事件通報的認知與通報執行態度，採橫斷式研究設計，以北部某市立聯合醫院為例，針對六個院區採普查方式進行。經醫院之IRB審核通過，並取得院方同意後，進行資料收集，共發出問卷1343份，回收問卷996份，有效樣本966份，有效回收率71.92%。研究工具採自擬之「護理人員對醫院異常事件通報認知與執行量表」，本量表經信效度檢定，效度採專家效度、信度採內在一致性檢定，Cronbach's α值為0.85。
研究結果：護理人員對醫院異常事件認知的答對率為88.70%，顯示認同醫院異常事件通報的重要。執行通報態度平均得分為3.76 ±0.76，顯見護理人員執行醫院異常事件通報態度高。執行通報時的障礙平均得分為3.50±0.77，可見護理人員在執行醫院異常事件通報時仍有中等以上障礙之考量，主要影響護理人員通報障礙因素是「通報後需書寫改善方案」、「擔心造成醫療糾紛」、及「成為長官評量能力之依據」。2.年齡越大、能力進階越高者對醫院異常事件通報的認知越高；其臨床年資、學歷及科別則會影響執行通報態度；通報醫院異常事件時，因年齡差異而有障礙的考量。3.醫院異常事件通報的認知與通報執行態度之間呈正相關，與執行障礙之間為負相關。
建議：1.成立改善小組，尋找事件發生根本原因並進行改善；2.確保通報系統的安全及隱密，避免護理人員「擔心造成醫療糾紛」；3.學校和臨床繼續教育應加強異常事件通報的內容及發生錯誤後之倫理討論。希望本研究結果可作為日後推動醫院異常事件通報工作之決策參考，進而能建構醫療安全環境，以增進病人安全。

關鍵字

醫院異常事件；基層護理人員；通報認知；通報執行；通報障礙

並列摘要

Patient safety has always been an important issue. Patients come into contact with nurses more than any other hospital staff. Therefore, nurses play a crucial role in patient safety, so the purpose of this study are to knowledge the nurses to explore the cognition and reporting of hospital incident. Using a cross-sectional studying design with Taipei City Hospital as an example, this is including 6 hospitals nurses for cases mining census way for; This design has passed the audit through The Taipei City Hospital IRB and also obtained the agreement form the hospital in collecting information data. We sent out questionnaires 1343 sets and returned back 996 sets. Total effective sample has 966 sets, effective return rate is 71.92%.The instrument was used a structured questionnaire which had passed through the creditable reliability procedures. Content Validity is using specialist & construct. Reliability is using internal consistency. Cronbach's alpha value is 0.85.
Results: The important results were summarized as following: 1.The nurses on the rate of hospital event cognitive score of 88.7%, display identity hospital informed of important exception events. Implement informed attitudes average score 3.76 ±0.76, it is evident that high performing hospital nurses informed the exception event. Implementation of communications barriers with an average score of 3.5 ±0.77, visible in the implementation of hospital nurses informed the exception event is still above the average obstacles considered major impediments to inform the nurse of which is "communication needed after writing improvement programme", "fear of medical disputes caused." and "became the basis for Executive evaluation capacity". 2.The nursing staff in older, higher capacity enhancement for the hospitals exception event reporting higher cognitive; also because of their clinical experience, qualifications and informed the branch don't affect the different attitudes of informed the hospital when the exception event, consideration of obstacles due to age differences. 3.The hospital informed the exception event between cognition and executive attitudes are related, for negative correlation with the obstacles to implementation, the hospital informed the exception event perform no significant correlation between attitudes and barriers to implementation. Recommendations: 1. Set up to improve the team, find the root cause of the incident and make improvements to reduce nursing staff informed the writing report and willingness to implement. 2. Nurses "worried cause medical disputes", recommended that health authorities to ensure the security and privacy of communications systems. 3. Hospital exception events has a significant relationship of cognitive attitudes, executive briefings and, it is recommended that school education and clinical continuing education should strengthen the event notification content. 4. no communication exception event within one year and accept a patient safety-related courses, proposed that, through observation and understanding does not inform, not to participate in clinical course of reason, and to the education and training to enhance cognition of nursing staff, regardless of the patients without causing harm to communicate and not be punished. 5. Nurses ethics-related training courses, joined the party after an error occurs on the error event right views and attitudes. These findings may be used as a reference for any medical organizations or the government agency seeking for improvement of patient safety.

並列關鍵字

medical incident repor ； nurse ； reporting cognition ； reporting attitude ； barriers

參考文獻

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