護理人員對「病人安全」認知之研究~以某區域醫院為例

An Empirical Study of Nursing staff’s Recognition of “Patient Safety”-- Data based on a Survey given in a General Hospital

許秀玲(Hsiu-Ling Hsu)

指導教授 ： 徐學忍

元智大學/管理學院/管理研究所/碩士(2007年)

https://doi.org/10.6838/YZU.2007.00265

摘要

92年2月行政院衛生署成立「病人安全委員會」，推動病人安全工作至今已邁入第四年，至96年已陸續推動「提升用藥安全」、「落實醫療機構感染控制」、「提升手術正確性」、「提升病人辨識的正確性」、「預防病人跌倒」、「鼓勵異常事件通報」、「改善交接病人之溝通與安全」、「提升民眾參與病人安全探討」等八項病人安全議題，各醫療機構也配合推展病人安全工作。居於臨床服務第一線的護理人員，不但24小時持續照顧病人，同時也肩負病人安全把關的重責大任，故其對病人安全認知情況，影響病人安全工作推動之成效甚巨。
本研究目的旨在透過實證研究，探討不同臨床年資、教育程度、教育訓練、進階層級、服務科系的護理人員，對於病人安全相關議題的認知差異性，及護理長與一般護理人員(護理師、護士)在病人安全認知上的落差，並探討其重要影響因素。
本研究使用問卷進行抽樣，抽樣對象選擇任職北部某區域醫院全體護理人員，共發出324份問卷，回收309份，有效問卷回收率94%，並以SPSS for Window 13.0 版統計軟體進行資料分析工作。
本研究主要發現如下：
從統計分析結果發現，臨床年資一年以上的護理人員、有參加病人安全相關教育訓練、進階層級N3以上、護理長職稱的護理人員，對病人安全的認知程度較高。而且、護理長與單位內不同臨床年資護理人員在病人安全認知上有顯著差異，不同科系部門的護理長與護理人員在病人安全認知上有差異，其中以內科系護理長與單位內護理人員間之安全認知的落差顯著高於其他科系，有四個科系的護理人員接受病人安全訓練時數，不足院方要求每年至少2小時。
依據上述結論提出下列實務面建議，以提供醫院管理者作為病人安全管理策略擬定之參考：
建議新進護理人員的職前教育，應包括病人安全之相關議題，及加強年資一年以下的護理人員「提升用藥安全」方面的教育訓練。將病人安全相關訓練課程列為N1晉升至N2系統性訓練重點，鼓勵護理人員積極參加進階訓練，將進階訓練由目前N1強制晉升至N2延長至N3，以增加護理人員安全的執業行為。並加強無罰責內部異常事件通報系統之宣導，讓民眾瞭解每一項醫療服務提供的過程，可以縮短醫病兩者間的認知差距，及維護病人自己就醫安全的權益。

關鍵字

護理人員 ； 認知 ； 病人安全

並列摘要

The “Patient Safety Committee” was established in February, 2003 by the Department of Health. Since then, the committee has worked with many hospitals on the following eight major goals: (1) Improving the safety of using medications, (2) Reducing healthcare associated infections, (3) Eliminating wrong site, wrong patient and wrong procedure surgery, (4) Improving the accuracy of patient identification, (5) Preventing patient falls, (6) Encouraging medical staff to report any incident, (7) Improving communication and safety during patient transfer and hand-over and (8) Increasing patients and customers involvement. Nursing staff are responsible for providing 24-hour clinical patient care and their knowledge of patient safety is critical to the success of implementing these goals and strategies.
The purpose of this empirical study is to identify the major relationships between several nursing staff variables (i.e. clinical tenure, education level, practical training, job promotion and assigned department) and the nurses’ patient safety recognition. The major factors that differentiate between head nurses and general nurse staff are also examined in this study.
This study uses a structured questionnaire with a patient safety recognition measurement built inside the questions. It also uses random sampling for selecting the research subjects from a group of nurses in a general hospital in northern Taiwan city. 324 copies of the questionnaire were distributed and 309 copies were returned back. This amounts to a 94% effective response rate. The raw data has been entered into a SPSS statistical program (on a Window V13.0 PC) for further analysis.
The major findings in this study are:
1.Nurses with 1 year (or more) of clinical tenure and nurses who have attended practical training and have been promoted to N3 level or head nurse have statistically higher recognition of patient safety.
2.Within a given department, there is a significant difference in patient safety recognition between head nurses and general nurse staff. Among the different departments, the internal medicine department shows the largest difference between the head nurses and general nurse staff.
3. Even the hospital has set the minimum required hours for patient safety training,nurses work at four departments have insufficient patient safety training hours.
Based on the findings, the following recommendations are made:
1.Providing the practical training for new nurse staff regarding patient safety will greatly improve their patient safety recognition.
2.Nurses with less than 1 year clinical tenure should be trained intensively in the safe use of medications.
3.Encourage all nurse staff to participate in advanced patient safety training. These advanced classes should be required for job promotions. It should especially be required for job promotions in the level N1 or N2 and also extended to level N3.
4.Encourage medical staff to report any patient safety incident without any punishment attached.
5.Improve customers’ communication and involvement in medical procedures. Customers can thus assist in assuring patient safety.

並列關鍵字

Nurse Staff ； Recognition ； Patient Safety

參考文獻

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