醫務社會工作者專業權能感對介入處理醫療爭議態度影響之研究

The study of medical social workers' perception of professional empowerment to influence their attitudes toward for intervening the medical dispute

賴宛瑜(Wan-Yu Lau)

指導教授 ： 陳武宗

高雄醫學大學/健康科學院/行為科學研究所/碩士(2005年)

摘要

摘要
本研究在瞭解各醫院醫療爭議處理運作制度及醫院社會工作部門介入處理醫療爭議現況，試圖了解不同組織特徵及個人特徵對專業權能感及介入處理醫療爭議態度的差異情形，進而了解醫務社會工作者專業權能感對介入處理醫療爭議態度之影響。本研究所指醫療爭議為病患或其家屬在求醫過程中對於醫事人員所提供之醫療行為、過程及結果無法接受或不滿意，包含醫療因素如醫療過失、醫療傷害，或非醫療因素如對人員服務態度與作業流程不滿意，而與醫院或醫事人員之間產生語言或肢體衝突的情境。
本研究以調查研究法的郵寄問卷方式獲取研究資料，以普查方式針對任職於符合行政院衛生署90-93年度醫院評鑑暨教學醫院評鑑合格名單之醫學中心、區域醫院社會工作部門(不含精神科)之醫務社會工作者進行調查，共寄發87間醫院，510份問卷，共回收70間醫院，333份問卷，其中330份為有效問卷，醫院回收率為80.46％，樣本回收率為65.29％。
本研究以描述性統計、因素分析、T檢定、單因子變異數分析、相關分析、迴歸分析等統計方法進行資料分析，主要發現如下：
一、醫院醫療爭議處理機制以「設有相關委員會或任務小組」、「設置專責單位」、
「設置專責人員」三者為最多，均佔91.43％。
二、社會工作部門有82.86％介入處理醫療爭議。在這些介入處理醫療爭議的醫院中，工作職位以「部門主管」63.79％居多，介入階段以「初步狀況了解階段」有98.28％為最多，介入內容以「情緒安撫」有96.55％為最多。
三、組織特徵與醫務社會工作者專業權能感僅一項有顯著差異，其為社會工作部門主管最高學歷教育背景
四、個人特徵與醫務社會工作者整體專業權能感部份有顯著差異，包括年齡、性別、婚姻狀況、宗教信仰、醫務社會工作總年資、工作職位、有無醫療爭議處理經驗。
五、組織特徵與介入處理醫療爭議態度均無顯著差異。
六、個人特徵與介入處理醫療爭議態度部份有顯著差異，包括年齡、性別、宗教信仰、工作職位。
七、整體專業權能感為正向，整體介入處理醫療爭議態度為正向，且兩者具顯著相關。且專業權能感之專業影響力與專業自我效能有助提昇醫務社會工作者介入處理醫療爭議態度，專業自主性及專業成長則未產生預期影響力。
本研究根據研究結果提出建議，提供社會工作管理者、臨床醫務社會工作
者、社會工作人員專業組織、社會工作教育工作者規劃課程之參考。

關鍵字

介入處理醫療爭議態度 ； 專業權能感 ； 醫務社會工作者

並列摘要

Abstract
The purposes of this study were to understand the current operational mechanisms of the medical dispute situation in hospitals, and how the social work department to intervene the medical dispute, and try to understand the differences perception of professional empowerment and the attitudes toward for intervening the medical dispute between the different organizational and individual characteristics, and then find the medical social workers’ perception of professional empowerment to influence theirs attitudes toward for intervening the medical dispute.
The survey questionnaires was implemented through mailed to all general, the medical social workers who worked in the social work department of 87 hospitals, which were accredited as the level of medical centers and district hospitals. Finally, 333 questionnaires were returned ,and 330 among these were valid. The return rate of hospitals was 80.46%, the return rate of samples was 65.29％.
The study was analysed with the statistic methods of frequency distribution, factor analysis, t-test, ANOVA, Pearson correlation and multiple regression analysis. The results of the study are as follows：
1. The 91.43 percent hospitals built the operational mechanism of the medical dispute situation , included setting specific committees or task force or setting the specific duty units or the specific duty staffs.
2. The 82.86 percent hospital social work departments intervened the medical dispute. However in these hospitals, there were 63.79 percent social work department directors. The 98.28 percent situation of the intervening stage was the stage of knowing the initial conflict situation. The most intervening service was offered by medical social worker to pacify the families and patients emotional problems.
3. There was a significant difference between organizational characteristics and perception of professional empowerment in different educational background of the social work department directors .
4. There were significant differences between individual characteristics and perception of professional empowerment in different age, sex, marital condition, religious belief, total medical social work seniority, work position and the experiences of intervening the medical dispute.
5. There were no significant differences between organizational characteristics and the attitudes toward for intervening the medical dispute.
6. There were significant differences between individual characteristics and the attitudes toward for intervening the medical dispute in different age, sex, religious belief and work position.
7. The perception of professional empowerment and the attitudes toward for intervening the medical dispute both trended positive, and there was significant correlation between them. The best factors among perception of professional empowerment to forecast the attitudes toward for intervening the medical dispute were professional impact and professional self-efficacy.

According to the results of study, I came up with some suggestion to social work managers, clinical social workers, social worker associations and social work educators.

並列關鍵字

perception of professional empowerment ； attitude toward for intervening the medical disp ； medical social worker

參考文獻

參考文獻

中文部分

丁惠民(譯)(2003)。調解衝突技巧立即上手。台北：麥格羅•希爾。(Dana,D.,2001)

王秀珍、盧美秀(1998)。護理人員工作相關灌能之探討-比較護理人員實際感受語期望間之差異。護理研究，6(1)，19-30。

王保進(2002)。視窗版SPSS與行為科學研究(再版)。台北：心理。