護理人員執行病人安全政策的工作壓力與因應行為之研究-以中部某區域教學醫院為例

A Study of Job Stress and Coping Behaviors of Nurses Performing Patient Safety Policy—An Example of a Regional Teaching Hospital in Central Taiwan

羅崇賢(Chung-hsien Lo)

指導教授 ： 楊智超

朝陽科技大學/管理學院/企業管理系/碩士(2010年)

摘要

護理人員是站在照顧病人的第一線人員，也是維護病人安全最後一道防線。現今在健保給付壓力下，醫院大幅縮減護理人力，面臨一連串嚴重的醫療疏失與新興傳染病的肆虐，使得病人安全與護理人員工作壓力更需被重視。
本研究以探討護理人員執行病人安全政策之工作壓力與因應行為為主要目的，對象以台中某區域教學醫院實際執行病人照護活動之護理人員為主，進行結構式問卷調查。問卷分析方法使用 SPSS for Windows 10.0 統計套裝軟體進行統計分析。
結果得知 研究對象以5年至10年的工作年資、未婚、無子女數、急重症病房、N1能力進階階層，以及一年內有接受病人安全與壓力因應課程之護理人員為主；74.9﹪護理人員所照顧的病人曾發生過病人安全事件；且曾發生過病人安全事件的護理人員近一年內尚有72.8%再次發生病安事件。護理人員執行病人安全政策時承受著中度到重度的工作壓力(3.41)，工作壓力來源以醫療團隊的壓力感最大、工作負荷的壓力感次之、專業能力的壓力感最低。壓力強度最高項目為當病人病情有變化，而醫生未能立即前來處理。護理人員承受工作壓力時，以採用問題取向之因應行為為主，最常採用因應方式是記取經驗且告訴自己絕對不讓同樣的事情再發生。
護理人員執行病人安全政策的工作壓力在病房型態、護理能力進階層級、有無病人安全意外事件以及近一年內病人安全事件發生次數等屬性變項，達顯著差異。整體工作壓力以急重症單位大於門診，護理能力進階N1層級在病人照顧、醫療團隊、行政管理的壓力感比未進階者為高。護理人員執行病人安全政策面臨工作壓力時，運用問題取向紓解工作壓力以工作年資10年以上、學士以上的護理人員，以及專科與急重症病房比綜合病房的護理人員，使用的頻率為高。
本篇研究結果有助於個人和組織對護理人員執行病人安全政策的工作壓力與因應行為有更深入的了解，並能提供政策制定、教育、實務及研究的參考，以提升與維護病人安全、減輕護理人員工作壓力，與增進正向因應行為。

關鍵字

因應行為 ； 病人安全政策 ； 工作壓力

並列摘要

The nurse was stand was care patient the first line personnel, also maintains the patient safety last defense line. Nowadays in the Taiwan''s National Health Insurance under the pressure, the hospital large deflation nursing manpower, faced with a succession of serious medical mistake and emerging infectious disease''s wreaking havoc, causes the patient safety and the nurse job pressure must take seriously.
The purpose of this study was to explore job stress and coping behaviors of nurse performing patient safety policy at the regional Teaching hospital in central Taiwan. Structurally formulated questionnaires and cross-sectional study are used. The collected data is processed and analyzed with computerized statistical software SPSS for Windows Version 10.0.
The result knew that the object of study by from 5 years to 10 year work period, unmarried, non-children number, critical- emergency unit, the N1 nursing clinical ladder, and in one year had accepts the patient safety and the pressure of nursing staffs primarily.74.9 % nurse care patient once had the patient safety incident; And once had in patient safety incident''s nurse near one year some 72.8% once more to be still sick the peaceful event. The results of this study indicated nurse performing patient safety policy job stress was on the moderate to higher level(3.41).
The biggest stress source of nurses performing patient safety policy is interpersonal relationship, working loading next best, and professional role -playing was less stressful. Among stressful items, top one was「when the patient condition has the change, delay support from doctors」。When the nurse withstands the working pressure, uses the problem focused coping primarily, the most used coping behaviors is bear the lesson in mind.
There is great significance between work stress and several variables of individual characteristics as follows: ward type, clinical ladder system, whether there was the patient safety incident, recently one year the patient security incident has the number of times.
Whole working pressure of the critical- emergency unit was bigger than the OPD. clinical ladder program of N1 at care Patient, interpersonal relationship, administrative management pressure feeling compared to not to enter the ladder high as.
When the nursing performing patient safety policy with the job pressure, solves the job pressure nursing staffs using the question orientation to work above for 10 years above the period of service, bachelor, as well as the faculty and the faculty and critical- emergency units ratio synthesizes ward often to use.
The study results increased our understanding about nurse performing patient safety policy and provided information for policy making, nursing education, practice and research, promotes and maintains the patient safety, to reduce the nurses job stress, with promotes forward in accordance to the behavior.

並列關鍵字

Patient safety policy ； Job stress ； Coping behavior

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