針對急診壅塞感知及相關照護品質與急性照護人員之職場疲憊之雙維性探討研究

A Dual-dimensional Study Exploring Perception of Crowding with Relevant Caring Quality and Fatigue among Acute Care Providers of Emergency Department

李佩玲(Pei-Ling Lee)

指導教授 ： 何啟功

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2013年)

摘要

急診壅塞造成醫療品質下降、醫病溝通不良等諸多問題，又急診高張力工作環境，使得急診醫護人員承受更大的壓力。本研究探討急診壅塞感知及相關照護品質與急性照護人員之職場疲憊狀況。
本研究對象為高雄地區一間醫學中心急診部門。採隨機抽樣方式，於白班、小夜班與大夜班，且在三個不同醫療區域隨機抽樣醫師、護理師、病患及家屬，訪問其當下對急診壅塞及醫療品質感知，並加上觀察員現場觀察狀況，紀錄其感受，共收集3,816筆資料。並搭配以雲端中心提供之急診即時數據計算出急診壅塞指數。
另外，於1.5年後追蹤94位急診醫師及護理師，使用「職場疲勞量表與工作特質量表」以了解急診醫護人員之疲勞狀況。運用SPSS19.0套裝軟體，以ANOVA與Linear Regression方式分析。
結果在急診醫療人員疲倦指數上，男、女性個人疲勞（56.7、61.6）、工作疲勞（51.1、57.2）、工作過分投入（47.8、45.1）、服務對象疲勞（41、46.6）皆屬高疲勞狀態。而無論是醫療提供者、醫療接受者或是觀察員，對於急診壅塞感知與醫療品質感知皆呈高度相關；再深入分析，可得急診壅塞感知及醫師與病患比率也呈高度相關。
綜合建議為提高醫療品質，可監測此項壅塞指數，當幾近壅塞狀態時，應立即啟動緊急應變措施，如調度醫護人力；並辦理急診醫護人員壓力監測、壓力紓解活動及提供溝通管道，以提升急診醫護人員之安全工作環境與身心健康。

關鍵字

急診壅塞 ； 急診醫護人員 ； 疲勞

並列摘要

Emergency department (ED) crowding not only affects ambulance diversion but also results many problems, such as quality of medical treatment in decline and poor communication between doctors and patients. ED doctors and nurses have greater pressure than other departments because of the busy and intense work environment. However, emergency department crowding comes into another problem which is ED medical personnel fatigue. The purpose of this study is to discuss emergency department crowding with relevant caring quality and workplace fatigue among acute care providers.
The objects are one emergency department of medical center in Kaohsiung. Doctors, nurses, patients and their families which were from the day shift, the later shift, the graveyard shift in the three different medical areas were sampled in a random method. They are asked the rank of crowding and level of medical quality, Observers recorded the situation at the same time. There were total 3,816 data. Cloud-Center provided real-time data to calculate department crowding Index.
After 1.5 years, 94 emergency doctors and nurses were tracked to fill in questionnaires in order to understand their fatigue conditions.
The questionnaire data, the ED crowding and level and medical quality are analyzed by SPSS 19.0 for Windows using ANOVA and Linear Regression.
The conclusions of Personal fatigue are as follows: males’ and females’ personal fatigue are 56.7 and 61.6; work-related fatigue are 51.1 and 57.2; work over-enthusiasm are 47.8 and 45.1; and fatigue of serve object are 41 and 46.6. All of them are high level of fatigue situation.
Perceptions of emergency department crowding and medical quality are all highly correlated among health care providers, health care recipients and observers. Moreover, it has relationship with emergency department crowding and the proportion of doctor to patient.
It is proposed to monitor the proportion of doctor to patient, if it was almost congested, emergency response measures would immediately activate, such as supplemental medical person. Monitoring emergency medical personnel pressure, stress relieving activities and providing communication channels should be held to enhance the safety and health work environment of emergency medical.

並列關鍵字

emergency department (ED) crowding ； emergency department(ED) medical personnel ； fatigue

參考文獻

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