技術混合照護模式之評價研究-以中部某區域醫院為例

The Study for Evaluation of Skill Mix of Nursing Model ─ An Example on a Regional Hospital in Middle-Taiwan

蘇臻芳(Chen-Fang Su)

指導教授 ： 楊漢湶 ； 胡月娟

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

為評估技術混合照護模式實施成效，以滿意度及醫療品質指標做為人力結構改變後的成效監測工具，研究對象為中部某區域教學醫院參與技術混合照護模式之家屬、照顧服務員、護理人員及醫師，採結構式滿意度問卷及焦點團體法，並了解需求者與供給者對比模式的主觀看法，參考實施期間相關醫療品質指標，以了解技術混合照護模式的試辦後成效。研究結果醫院家屬及護理人員在滿意度前後測的變項均無差異；無論供給者或需求者對於技術混合照護模式皆表示極正向的意見。在焦點團體法中，醫療品質是受訪者最注重的議題？再者，此模式減輕家屬的經濟負擔是為多數受訪人員認同的。醫療品質指標，除了跌倒受傷率外，其餘皆顯示參加技術混合護理模式病人之各項指標數據高於未參加技術混合模式的病人，因影響指標的因素很多，尚不能以此結果表示參加者照護品質較差。針對研究結果提出下列建議，(一)政策方面：應持續推行並求醫院間一致化，擬訂配套措施，避免濫用成為規避人力成本的手段；(二)財源籌措：考量財源籌措的特性，建議以病人自費及健保部分補助；(三)執行：執行機構應有促使專業及輔助人力間合作及教育的機制；(四)病人分類：國際間無一致標準，建議採醫護人員專業判斷及病人負擔能力下，做為選擇不同的照顧人力比分類為考量；(五)未來研究方向：針對不同醫院間比較，增加個案數，使統計結果更為客觀；若病人為意識清楚、溝通無礙，可針對病人了解其滿意度。

關鍵字

照顧服務員 ； 技術混合照護模式 ； 滿意度 ； 看護 ； 護理模式

並列摘要

In order to look after Skill Mix of Nursing Model implementation result, does take the result monitor tools embrace the degree of satisfaction and quality indicators after the manpower structural changed. The object of study for a region hospital join a pilot project of Skill Mix of Nursing Model, to look after the patients’ folks , the service person, the nursing staffs and doctors. By structural formula degree of satisfaction questionnaire and focus group understanding demand and supplier's subjective view, and reference implementation period related quality indicators.In the findings, the patients’ folks and the nursing staffs measure variable around the degree of satisfaction do not have the difference; Regardless of the supplier or the demand looks after positive attitude towards Skill Mix of Nursing Model. In focus group , The medical quality is the subject which the participant most pays great attention, Lightens the folks’ economic burden is approved by the most being interviewed personnel. The medical quality indicators, besides tumbles being injured rate, other all demonstrated that patients join a pilot project, indicators’ data is higher than has not participated, because the influence indicators' factor are many, could not by this result express that the participant looks after the quality to be bad.Suggested in view of the findings, (1) policy suggestion: Should carry out and cause between continually the hospital the uniformization, and drafts the coordinated sets of measures, avoids abusing into the circumvention manpower cost the method; (2) The source of funds: The consideration source of funds, suggested that pays own expenses and the health insurance part subsidy by the patient;(3) implementing agency should have urges during specialized and the auxiliary manpower the cooperation and the education mechanism; (4) patient classifies internationally not consistent standard, suggested that picks the medical care personnel specialized judgment and the patient bears under ability, does compares the classification for the choice different attendance manpower is the consideration; (5) study in the future: In view of the different hospital between the comparison, increases the case number, causes the statistical result to be more objective; If the patient is clear for consciousness, communication unobstructive, may aim at the patient to understand its degree of satisfaction.

並列關鍵字

skill mix ； job satisfaction ； nursing auxiliary

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