護理人員醫療異常事件通報意向之探討-以台南不同層級醫院為例

Nursing staff’s behavioral intention toward reporting medical incidents among three levels of hospitals in Tainan area

楊雲湘(Yun-Hsiang Yang)

指導教授 ： 陳金淵

長榮大學/健康科學學院/醫務管理學研究所/碩士(2010年)

摘要

目的 為改善醫療錯誤或疏失並避免醫療糾紛，醫療異常事件通報是有效方法之一，但目前醫療院所面臨的問題卻是醫療異常事件通報不足，且隨著醫院層級之不同，通報率亦有所不同。本研究以PRECEDE-PROCEED模式為理論架構，探討不同層級醫院之護理人員對醫療異常事件通報行為意向之差異及影響因素。

方法 本研究採橫斷式設計，以便利抽樣方式選取台南地區四家不同層級教學醫院中具有執照之臨床護理人員為研究對象。研究工具為結構式問卷，內容包括個人基本資料、素質因素（通報認知、通報態度量表）、增強因素（個人經驗）、促進因素（組織通報文化量表）及行為意向量表。於2009年4月13日至4月28日期間，發放330份，回收有效問卷318份（回收率98.1％）。所得資料以描述性統計、單因子變異數分析、皮爾森積差相關分析及階層廻歸分析進行處理。

結果 不同層級醫院間，護理人員對醫療異常事件之通報行為意向有差異，其中以地區級醫院較弱；通報認知及態度亦存在差異，以醫學中心對認知較為瞭解，而區域和地區級醫院則是較注重已發生的傷害才會通報；組織通報文化也有所不同，以醫學中心較有整體性，而地區級醫院較弱。素質因素、增強因素與促進因素對通報行為意向皆呈正向相關，其中，增強因素之「教育訓練」、「有曾經通報異常事件」、「應通報未通報」、「有填寫異常事件報告」、「通報的處罰」及「通報的責任歸屬」等個人經驗會明顯影響通報行為意向；通報認知、態度與組織通報文化彼此亦會互相影響。異常事件通報行為意向的影響因素中，「素質因素」有35.7％的解釋力，加上「增強因素」則解釋力可以達到41.3％，再加入「促進因素」則解釋力可逹42.3％。

結論和建議 不同層級醫院通報行為意向之差異可能源於組織通報文化，以醫學中心之整體表現最優，層級愈低之醫院，愈需要建立組織通報文化來帶動通報行為意向。本研究結果可提供不同層級醫院領導者規劃醫療異常事件通報制度及策略並舉辦相關教育訓練活動時之參考。

關鍵字

醫療異常事件 ； 通報行為意向 ； 通報認知 ； 通報態度 ； 通報文化

並列摘要

Objectives The medical incident reporting system is one of the effective methods to reduce medical error, negligence and the disputes aroused; however, the low reporting rate is the major problem faced by hospitals, which also varies by hospital level. This study adopts the PRECEDE-PROCEED model as the theoretical framework, and examines the differences in behavioral intention towards the medical incident reporting system among nursing staffs at different levels of hospitals.
Methods Based on a cross-sectional design, this study used a random sampling strategy to select licensed clinical nursing staffs from four teaching hospitals across three different levels in Tainan area. A structured questionnaire was developed to collect participants’ demographical information and responses to the predisposing factors (perception of and attitude towards the reporting system), enhancing factors (personal experiences), motivating factors (organizational reporting culture), and behavioral intention. During the time period from April 13th to 28th in 2009, 330 copies of questionnaires were distributed and 318 effective copies were collected (a response rate of 98.1%). The data analyses were performed by descriptive statistics, one-way ANOVA, Pearson product-moment correlation, and hierarchical regression modeling.
Results Nurses at different levels of hospitals presented different behavioral intentions with regards to medical incident reporting; in particular, nurses at district hospitals had lower reporting rates. Variations also existed among perceptions of and attitudes towards the reporting system; for example, personnel at medical centers had more accurate perceptions of incident reporting while personnel at district and regional hospitals usually reported incidents only when injuries occurred. In addition, reporting cultures in organizations were also different as medical centers had a more integrated reporting mechanism than district hospitals. To sum up, predisposing, enhancing, and motivating factors were all positively correlated to reporting behaviors and intentions. In particular, personal experiences under enhancing factors of “educational training,” “previous experiences of reporting,” “failure to reporting,” “previous experiences of drafting incident reports,” “punishments for reporting,” and “attribution of reporting responsibility” all significantly affected individuals’ reporting intentions. Besides, individuals’ perceptions, attitudes and organizational cultures concerning reporting also had impacts on each other. Among all the factors associated with reporting behaviors and intentions, predisposing factors accounted for 35.7% of the explanatory power. The explanatory power was elevated to 41.3% after incorporating enhancing factors, and to 42.3% after incorporating motivating factors.
Conclusion and Suggestion The differences in reporting behaviors and intentions across different levels of hospitals may largely result from organizational reporting culture. While medical centers reveal a higher reporting rate, lower level hospitals depend more on the reporting culture to encourage reporting behaviors and intentions. The results hope to provide for hospital managers as references for designing the medical incident reporting system and for developing relevant education training activities.

並列關鍵字

medical incident reporting system ； behavioral intention ； perception of reporting ； attitude toward reporting ； and reporting culture

參考文獻

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