急診護理人員與緊急醫療救護人員交班完整性及其相關因素之研究

Study of emergency department nurses and Emergency Medical Technicians' integrity of handover and it associated factors

蘇怡如(Su Yi-Ju)

指導教授 ： 胡益進 ； 李子奇

國立臺灣師範大學/教育學院/健康促進與衛生教育學系/碩士(2022年)

https://doi.org/10.6345/NTNU202200942

摘要

完整且準確的交班為病人安全非常重要的一環。本研究主要目的在瞭解急診護理人員與緊急醫療救護人員交班時社會人口學特質、交班系統與相關訓練、病人及病情狀況對交班完整性的影響及相關性，期許未來雙方能夠理解彼此作業流程與交班共識，建立統一交班格式，減少衝突，提升護理救護品質，保障病人安全。
本研究對象為2022年全台急救責任醫院急診護理人員為母體群，因無法取得確切母體數，以G-power統計軟體做主要樣本數計算。採便利取樣方式，取雙北市急救責任醫院急診護理人員為樣本，並自編結構式調查問卷線上進行資料收集，以單因子變異數、皮爾森積分相關、多元回歸模式進行分析，共得樣本數為101份。本研究結果如下:
一、研究對象的交班系統與相關訓練、病人及病情狀況平均得分均屬中高程度認同。
二、交班完整性以ISBAR(Introduction、Situation、Background、Assessment、Recommendation英文字母的縮寫)內容重要性之認知為依據，其中非常重要項目佔所有比例36%。
三、研究對象的社會人口學在交班系統與相關訓練、病人及病情狀況、交班完整性無顯著差異。
四、研究對象的交班系統與相關訓練、病人及病情狀況與交班完整性有顯著相關，表示交班系統與相關訓練越完善、病人參與度越高及病情狀況越複雜嚴重，影響交班完整性越高。
五、研究對象的交班系統與相關訓練對交班完整性為主要重要預測因子，可解釋總變異量的51.8%。
結論:交班系統與相關訓練是交班完整性主要的重要預測因素，建議可共同辦理相關在職教育及技術訓練課程、同步改變交班方式及作業系統、制定交班格式口訣，找出問題提出解方，期待提升病人安全品質。

關鍵字

急診護理人員 ； 交班完整性 ； 交班系統與相關訓練 ； 病人及病情狀況

並列摘要

Completeness and accuracy of patient handover play an important role in patient safety. This study aimed to understand the impact of Population Sociology, the handover system and its related training, patient and medical condition between the emergency medical technicians (EMTs) and the nurses in the emergency room when they do the handover. Therefore, both of them, emergency medical technicians (EMTs) and the nurses in the emergency room, can comprehend the work process, reach a consensus to establish a unified patient handover format, reduce conflicts and improve nursing rescue quality to ensure patient safety.
The study subjects are all the nurses in the emergency room who work in basic level first aid duty hospitals in Taiwan in 2022. Due to the exact population cannot being obtained, the G-power software was used to calculate the main sample number. Convenience Sampling was conducted to take emergency nursing staff in basic level first aid duty hospitals of Taipei City and New Taipei City as samples, by using self-compiled structured questionnaires and one-way ANOVA, Pearson’s Product-moment Correlation, and Multiple Regression Analysis for statistical analysis, a total of 101 samples were obtained. The results of this study are as follows:
1.Handover system & Related Training and Patient & Disease Status of the research subjects are in the middle to the high level of recognition.
2.The completeness of shift handover is based on the importance of ISBAR as the basis for complete cognition, with very important items accounting for 36% of all items.
3.There is no significant difference in the Social Demography, Handover system & Related Training, Patient & Disease Status, and Handover Integrity of the research subjects.
4.There is a significant correlation between the Handover system & Related Training and Patient & Disease Status of the research subjects. Indicating that the fully functional Handover system & Related Training, the higher patient participation, and the more complex and serious disease conditions affect the integrity of patient handover.
5.The handover system & related training are the main predictors of handover integrity, which can explain 51.8% of the total Measures of Variation.
The handover system & related training are the main predictors of handover integrity, according to the research result, providing the relevant education and technical training courses, simultaneously changing the handover method and operating system, formulating handover format, identifying problems, and proposing solutions were suggested to improve the quality of patient safety.

並列關鍵字

Emergency Nurses ； handover integrity ； handover system and related training ； patient and condition

參考文獻

Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O’Toole, J. K., Solan, L. G., Aylor, M., … Landrigan, C. P. (2014). Changes in Medical Errors after Implementation of a Handoff Program. New England Journal of Medicine, 371(19), 1803–1812. https://doi.org/10.1056/nejmsa1405556

中文文獻

中華民國內政部消防署全球資訊網 緊急救護統計. (2020). https://www.nfa.gov.tw/cht/index.php?code=list&ids=221.

劉寶玲、戴辛翎、林貴滿. (2009). 提昇急診病人轉送病房護理交班完整性方案. 志為護理-慈濟護理雜誌, 8(4), 82–92.

台灣醫策會病人安全通報系統 TPR統計報表. (2020). https://www.patientsafety.mohw.gov.tw/Content/Downloads/List01.aspx?SiteID=1&MmmID=621273303702500244.