運用簡易多屬性分析於加護病房與急性病房護理人員輪 調意願之研究-以南部某區域教學醫院為例

Study on the willingness to rotate the intensive care unit and acute ward nursing staff with simple multi-attribute analysis-An Example of a Regional Teaching Hospital in Southern Taiwan

馬翠婷(Tsui-Ting Ma)

指導教授 ： 黃怡詔

國立屏東科技大學/管理學院/高階經營管理碩士在職專班/碩士(2019年)

https://doi.org/10.6346/NPUST201900118

摘要

急性病房護理人員年資淺，處理病人危急事件欠缺重症經驗，常成為病人安全之隱憂，若能調入具加護病房經驗之護理人員協助帶領與指導將大幅提升臨床照護品質。本研究目的在探討影響加護病房護理人員轉調急性病房的相關因素，本次研究訪談的對象為現任具有重症加護病房實務經驗之護理人員。其研究方法經由對問卷訪談內容進行收斂並加以歸納整理，整理成簡易多屬性評估技術SMART(Simple multi-attribute rating technique)屬性定義之決策模式，並利用排序次序重心權重法(Rank order centroid weights, ROC)對各屬性給予權重加以討論及分析。根據研究結果所得到影響加護病房護理人員轉調病房的原因之決策模式共區分為六個類別屬性，權重依序為:服務對象、

輪調單位特性、醫療糾紛、專業成就、工作流程、排班薪資，總計共有二十四個屬性。
加護病房護理人員面對輪調至急性病房有很大的擔憂，若透過入院時診療計畫完整告知及執行各項措施之前做充分說明，醫療團隊表現專業之明確以降低家屬不安進而干預治療，於環境與流程皆須耗用能量來調適，若透過完善的學習計畫來引領輪調的護理人員，將可協助輪調者盡快接軌臨床護理工作。擔心異常事件與醫療糾紛發生，建議管理者應加速讓醫療設備資訊化，強化醫療糾紛之預防與警覺，以提升處理衝突能力。擔心自主性降低，可藉由持續定期舉辦在職教育及鼓勵進修，培養敏銳觀察力發覺內在的同理心，以提昇護理工作滿意度，加強臨床團隊運作模式訓練來克服此項影響因素。工作流程改變與繁瑣是接受輪調護理人員的阻力，藉由將急性病房單位之工作流程予標準化，簡化流程將有助轉調之意願。護理人員最在乎的是超時問題，可藉由單位會議擬定三班護理常規工作之分配，啟動團隊模式以解決超時問題，增加臨床輔助人力協助病房家屬與護理人員，將減輕兩者壓力與負擔，未來進行相關研究可將研究對象擴增到鄰近同等級醫院，能更真實呈現輪調意願。

關鍵字

加護病房 ； 工作輪調 ； 簡易多屬性分析

並列摘要

Personnel staffing emergency wards are of a lower seniority and thus lack critical experience when it comes to the handling of emergency situations. This often is a cause for concern when it comes to the safety of patients. However, if experienced ICU nursing staff could be brought in to help lead and offer direction, it could greatly improve the quality of clinical care in such wards. The objective of this study is to explore the related factors for why ICU nursing staff are not being rotated into emergency wards. Current nursing staff with critical ICU experience were interviewed for this study. The study organized information that was gathered via questionnaires and interviews according to the simple multi-attribute rating technique (SMART) to create a decision model for the defining attributes. The rank order centroid (ROC) equation was used to determine the weights to be assigned to each attribute prior to conducting the discussion and analysis. According to the research results, the decision model for reasons impacting the rotation of ICU nursing staff into the emergency wards was divided into six categories of attributes. The order of weightings was: objects of service, characteristics of rotation units, medical disputes, professional achievements, workflow, and scheduling salary. There were a total of 24 individual attributes.
The ICU nursing staff were greatly concerned about the idea of being rotated into the emergency ward. If, at the time of admission, treatment plans can be made clear, and prior to the execution of various measures, ample explanations can be provided, the professionalism of the treatment teams will be demonstrated more clearly. This will help reduce the unease of family members and the likelihood that they interfere with treatment. With respect to environments and procedures, efforts must be made in order to adapt. Through comprehensive learning programs, nursing staff can be prepped for rotation; this could expedite the processes of getting those being rotated on track for the clinical care work. Regarding concerns for unusual circumstances and medical disputes, it is recommended that managerial staff allow for rapid informatization of medical equipment to increase the prevention and awareness of medical disputes, and improve the ability to handle conflict. Regarding concerns that autonomy will be reduced, sustained periodic on-job training can be conducted and staff can be encouraged to enroll in advanced education to cultivate acute observation skills and develop empathy. This can help raise the satisfaction levels of nursing work, improve operations models, and advance the training of clinical care teams, thereby helping to overcome the deterring factors. Different or cumbersome workflows also deter nursing staff from accepting rotations. By standardizing the workflow of emergency wards, simplified workflows will help improve willingness to accept rotations. Of greatest concern was the issue of overtime. Regarding this problem, unit committees could establish a conventional three-shift job allocation schedule to mobilize the teams and resolve issues of overtime. Increasing the auxiliary human resources for clinical care will be helpful to family members and nursing staff of patients in the ward and greatly alleviate their stress and burdens. In the future, when conducting related research on this subject, the scope could be expanded to include other hospitals of the same level in the neighboring area to further demonstrate attitudes of willingness with respect to job rotations.

並列關鍵字

Intensive Care Unit ； Job Rotation ； Simple Multiple-Attribute Rating Technology

參考文獻

王梅貴、周傳姜（2009）。護理人員跨科訓練之生活經驗．護理雜誌，56（2），33－41。

王梅貴、林淑媛、周傳姜、陳美杏（2010）。護理人員跨科訓練之學習經驗．護理暨健康照護研究，6（2），99－105。

古金英（2001）。建立一個輪調環境下受輪調員工的壓力員模式-以銀行業為例．人力資源管理學報，1（3），1－25。

安雅莉（2012）。某醫學中心加護病護理人員工作輪調之壓力及其相關因素之探討．義守大學碩士論文。

吳安綺、彭台珠、彭少貞、黃寒裕、李茹萍（2008）。加護病房護理人員對職業危害的擔心程度與因應策略之探討．志為護理，8（3），70－80。