診所護理人員執業處境之探討

A Study on Nurses’ Working Conditions in Primary Care Clinics

林呈蓁(Cheng-Jhen Lin)

指導教授 ： 尤素芬

義守大學/醫學院/醫務管理學系/碩士(2014年)

https://doi.org/10.6343/ISU.2014.00263

摘要

隨著台灣經濟的發展與人民健康意識的提升，民眾對於健康品質的要求也相對提升。診所是基層醫療的守護者，也是面對病患的第一線，診所護理人員的勞務情況攸關病患的就醫品質。許多研究指出，多數護理人員感覺執業處境壓力大；不過，既有研究取樣上偏重於醫院，對診所護理人員的理解相對較有限。
本研究採取質性研究法，探討西醫診所開業最多前五科—即內科、小兒科、耳鼻喉科、家醫科及牙科--護理人員的工作情況與執業處境，並特別關注護病關係間的情緒壓力及其肩負處理醫病之間的溝通角色。我們藉由面對面訪談的方式瞭解診所護理人員在制度、組織及個人面向的處境，試圖指出改善護理人員執業處境的可能方向。在當前台灣社會各界高度關切護理人力短缺問題之時，我們認為基層診所護理人員的勞動與社會處境也需要獲得適當的關注。
整體來說，診所護理人員雖不用臨床照護病患，但會有延遲下班、職業安全健康危害、人力不足、社會支持的需要、情緒管理、護病互動及醫護互動等問題發生。另外，診所護理人員的工作內容很多元，像是配合促銷活動的要求已超出了護理的執業範圍，而欠缺同儕彼此督促、一起成長的機會，以及無暇從事進修活動等問題，也都造成專業成長受限的困境。診所護理人員是基層醫療的守護者，也是面對病患的第一線，診所護理人員的勞務情況也攸關病患的就醫品質，呼籲政府、診所管理者及社會各界應關注診所護理人員的工作處境。

關鍵字

診所 ； 護理人員 ； 執業處境 ； 工作壓力 ； 專業成長

並列摘要

With the economic development and the increasing of people's medical knowledge, people in Taiwan require more and more high quality health care. Clinics are just like guardians of primary care, and they also are in the front line of facing patients. Therefore, clinic nursing staffs’ working conditions have lots to do with patients' medical quality. Researches indicate that many nurses are under the pressure of their working conditions. Nevertheless, most of existing researches have a bias towards hospitals rather than clinics when taking samples. Hence we have less understanding about clinic nurses.
Based on the qualitative approach research this study examines into the clinic nurses working conditions in top five different departments of western medicine- that is, internal medicine, pediatrics, E.N.T, family medicine, and dentistry. This study concentrates on the emotional stress between nursing staff and patients and, the nurses' roles in dealing with the communication of physicians and patients. By face-to-face interviews, we endeavored to understand the clinic nursing staff working situations located in systematic, organizational and individual dimensions. In so-doing, we tend to indicate a direction for improving nursing staffs' working conditions. Now in Taiwan society, people always concentrate on the lack of nursing human resources. However, we think that clinic nursing staff working conditions and social conditions need more attention.
In terms of clinic nursing staff working conditions, there were many problems being observed such as late for work, occupational safety and health hazards, lack of manpower and the need for social support, emotional management, interaction between nurses, patients and physicians. We also found that the content of clinic nurses is very diverse, and some of their jobs obviously exceed the domain of nursing work, such as products sailing. In addition, they are short of the opportunities of growing together with other nursing colleagues and continuing education. Therefore, they are faced with the difficulty of limit professional growth. Since clinic nursing staffs’ working conditions have lots to do with patients' medical quality, we suggest more attention to be paid to the improvement of their working conditions.

並列關鍵字

primary care clinics ； nurses ； working conditions ； work stress ； professional development

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