探討醫護周哈里窗與訊息置入對病患遵從醫囑意願之影響

本研究目的以周哈里窗理論為基礎，以不同訊息置入方式，並考量醫病雙方溝通時不同的壓力情況下，探究醫病關係與病患遵從醫囑意願程度之差異，然而，過去以周哈里窗理論應用於醫病關係的研究付諸闕如，因此本研究藉由發展醫護周哈里窗理論，落實醫病關係建立之初能明確定位，而善用合適之訊息置入方式，以達到良好醫病溝通，並提醒醫護人員反思，當病患不願遵從醫囑治療的背後原因，還有其存在的壓力考量，促進醫病雙方能達到醫病共享決策(Shared Decision Making, SDM)，提升病人參與及遵從醫囑意願，為醫病關係研究開啟新的里程碑。本研究以南部某區域教學醫院之住院病患及其主護護理師為研究對象，共計200份有效成對樣本；以SPSS 23.0 進行統計分析檢驗信效度、相關係數、變異數、二因子變異數分析及假設驗證。研究結果：(一)定義「醫護周哈里窗」四種醫病關係型態：參與型、指導型、諮商型、權威型；(二)參與型醫病關係型態其遵從醫囑意願程度較佳； (三)喚醒性之訊息置入方式對病患遵從醫囑意願之說服效果較佳; (四)病患財務壓力大相對遵從醫囑意願較低，此外，本研究訊息置入的方式對「醫護周哈里窗」與病患遵從醫囑意願程度並無交互作用效果，說明處於不同型態的醫病關係時，醫護人員以不同的訊息置入方式溝通時，仍要兼顧病患個別性的需求或困難，考量壓力源之所在，才能有效提升遵從醫囑治療之意願。本研究結果可提供醫療或非醫療機構內相關之專業人員，在與其溝通對象互動時，可結合醫護周哈里窗的概念，定位醫病關係型態，進而改善自我與他人之間的互動關係之參考，並且能善用溝通的輔助工具，將各種圖卡的訊息，製作為該專業所需的內容，成為各領域專業人員製作海報之素材，加以運用，增加訊息傳遞的有效性，建議後續研究者能針對四種不同型態之醫病關係深入探討，發展一套標準作業流程或量表，讓醫病關係都能趨近於參與型，促進醫病和諧。

關鍵字

醫病關係；遵從醫囑；訊息置入；周哈里窗理論；醫病共享決策

並列摘要

The purpose of this study is to introduce the “Johari Window” as a basic tool to illustrate how providers and patients differ under pressure nowadays. There’s a critical difference between providers and patients. This study also explains how “Johari Window” is effectively used to understand the difference in perceptions from providers and patients by exploring the Doctor- patient communication and medical compliance. However, most of these kinds of study programs are unproductive in the past years. This study tries to develop the Johari Window theory and shares strategic insight of it. The Physician-patient relationship has been and remains a keystone of healthcare. It’s all enlightened based on the theory of Johari Window. This is important in the delivery of high-quality healthcare. It lies at the heart of healthcare and we may make good use of the message insertion for buliding the better and productive physician-patient relationship in the future. “Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of physician-patient relationship.” Providers should reflect and target interventions to find out the factors affecting non-compliant behavior, deal with the pressure management, and also encourage patients to get involved with their health. This is recognized as a significant public health issue that the non-compliant behavior leads to poor health outcomes. The efficiency of this relationship depends on the satisfaction of the patient and we sincerely hope the physician-patient relationship may be more efficient and reliable and becomes better than ever before. In this study, the inpatients and the main nurses at a teaching hospital were selected as the target research group in southern Taiwan. A total of 200 valid paired samples were obtained. SPSS 23.0 was used for statistical analysis of reliability and validity, correlation coefficient, variance, two-factor variance analysis and also hypothesis verification. The final study result: (I) the four different kinds of Physician-Patient relationships are redefined as types of participatory, guidance, consultative, authoritative. (II) Participatory physician-patient communication is the best approach for medical compliance. (III) Awakening message placement is better at persuading patients to follow medical compliance. (IV)Finance factors truly affect therapeutic compliance. Furthermore, this study shows that there is no interactive effect on the patient compliance by using the message insertion from the Johari Window theory. Providers should use proper communication methods based on every patient’s need. On the other hand, providers not only need to overcome the gender barriers to communication, but also need to find out the main pressure sources in order to improve medication compliance. The result of this study may offer to all professionals and patients to understand the implication application Johari Window theory for building and improving great and successful interpersonal relationship. The Johari Window model may be comprehensively used when exploring the patient’s perspective through reflective listening by providers. Professionals may make good use of the auxiliary tools and the various education cards to be some of the materials to enhance the Physician-patient Relationship. I may suggest that people may further discuss and explore the four different kinds of types about the detailed development of the Physician-Patient Relationship. We may soon develop the effective standard operating procedures and scale in order to reach effective healthcare delivery for all providers and patients. This good relationship fosters better communication, which improves diagnosis. It finally leads to better health outcomes for all patients.