產婦生產就醫經驗 ~ 以某區域教學醫院為例

背景：近年來，病人就醫經驗逐漸成為衡量醫療照護品質的重要指標，更是達到以病人為中心照護的核心。在現今少子化的社會中，產婦對於自己即將經歷的生產過程愈加重視；個案醫院亦為提供產婦優良的服務品質，於新建大樓內開設全新的產科病房以滿足就醫產婦的需求，並使其留下美好的就醫經驗。目的：探討產婦生產服務過程的就醫經驗與住院期間對於醫療照護之評價，盼能藉著產婦的回饋，不斷精進服務品質。方法：本研究採橫斷式調查研究，收案對象為於個案醫院生產之產婦，問卷內容包含基本資料、生產服務就醫經驗與對生產照護之綜合評價，並將就醫經驗區分為醫師服務、護理服務、照護過程、資訊提供與環境等構面。共發放 305 份問卷，回收有效問卷 302 份，回收率為 99.02 %。統計分析包含敘述性統計、t 檢定、單因子變異數分析(ANOVA)、皮爾森積差相關分析與複迴歸分析等。結果：本研究結果發現就醫經驗各構面間均有顯著相關，其中護理服務與照護過程具有高度正相關，其餘構面則除了環境構面與醫師服務、護理服務二構面為輕度相關外，其餘則為中度正相關。複迴歸分析中則發現，同一位醫師產檢與生產，有助於提升產婦生產經驗；高中職以下與多胞胎產婦對環境構面經驗感受平均分數較低；無職業或家庭主婦相比在職中之產婦以及家庭年收入在 41-60 萬元者，對於照護過程的經驗感受較低；無職業或家庭主婦以及距離醫院交通時間 10-19 分鐘者對於資訊提供構面經驗較低。在綜合評價上，醫師的綜合評價僅與醫師服務構面有顯著關聯。而護理服務、照護過程以及環境的經驗越好，則對護理師的綜合評價顯著正向關聯。資訊提供構面與環境構面的得分越好，則對環境的綜合評價越高。照護過程、資訊提供與環境構面的得分越高，則整體照護的綜合評價越高。結論：產婦個人特性與生產特性，對其就醫經驗的認知有顯著相關。在照護過程中，真正影響產婦對於護理照護評價的構面是在住院期間的護理照護以及住院照護過程的經驗。整體而言，護理服務對於產婦多面向的就醫經驗具有更大的影響力。而生產前資訊提供的困難則是造成產婦綜合評價較低的原因，此部分可以透過「醫病共享決策」(SDM)之推動來加以改善。

關鍵字

產婦照護；綜合評價；病人經驗；生產

並列摘要

Background: In recent years, patients experience has gradually become an important indicator to measure the quality of care, and also the core to achieve patient-centered care. In today's society of declining fertility rate,mothers are paying more attention to the overall experience of the childbirth process. The case hospital also provides excellent service quality for mothers, new obstetric wards were opened to meet the needs of mothers to leave a good experience. Objective: The experience of maternal service and the evaluation of healthcare during hospitalization for childbirth process would be explored to improve the service quality through patient feedbacks. Method: A cross-sectional survey was conducted to survey the mothers who admitted for childbirth in the case hospital. The questionnaire included sociodemographic information, patient experience of childbirth services and global evaluation for healthcare. The patient experience was divided into physician services, nursing services, care process, information provision and environment. A total of 305 questionnaires were received, and 302 were effective, with a response rate of 99.02%. Statistical analyses included descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient and multiple analysis. Results: The results of this study showed that there was a high positive correlation between nursing services and care process, while other factors were moderately positive correlated with the exception to the environment, physician services, and nursing services for mild correlation. Regression analysis found that having the same doctor in obstetric examination and delivery would improve the childbirth experience. Mothers of high school or lower education and of multiple births had low experience in terms of environment. For those who housewives and without occupation and with annual family income of 410,000 to 600,000 NTD, they showed low experience in the caring experience. These who housewives and without occupation and those who had 10 to 19 minutes traveling time also had lower experience in term of information provision. In terms of overall evaluation for physicians, patients only cared about the experience of physician care. As nursing services, care process and environment improved, these factors contributed positively to the overall evaluation of nurses. Higher scores of information provision and environment would improve the overall evaluation of the environment. Higher scores in care process, information provision and environment would increase patient’s evaluation in the overall care. Conclusion: There was a significant association between the personal characteristics of mothers and the characteristics of labour to their cognition of the experience. During the care process, the real influence of maternal evaluation of such service was the in-hospital care and the experience of in-hospital care process. In general, nursing services did impose more impact on multiple aspects of maternal experience for patients. The difficulty of information provision was generally the reason for low global evaluation of maternity service, which could be improved by encouraging shared decision making (SDM) before labour delivery.