急診各級檢傷分類護理人力配置需求之探討

Exploring the Needs of Nursing Manpower for Different Triage Levels in the Emergency Department

沈永釗(Yung-Chao Shen)

指導教授 ： 張文英

臺北醫學大學/護理學院/護理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00121

摘要

急診是提供急重症病人緊急醫療照護之場所，而護理人力配置的多寡與病人照護品質息息相關，故本研究目的旨在(一)了解與分析急診各級檢傷病人所需之護理處置工時耗用情形。(二) 比較北、中、南、東之醫學中心急診部各級檢傷病人護理活動介入之差異。(三) 了解與分析急診各級檢傷分級所需之護理人力配置相對比例。
本研究設計為描述性相關性研究，於台灣北部某醫學中心急診部進行，本研究對象為急診病人與急診護理人員。以自擬之護理活動紀錄表，紀錄各級檢傷病人的護理處置活動項目、頻率及直接護理工時。另以結構性問卷調查19家分佈於北、中、南及東部的醫學中心急診部護理人員，以了解相關護理處置之介入程度及差異。資料收集後採SPSS17.0版套裝軟體進行資料分析，以敘述統計分析與推論性統計如獨立樣本t、Spearman correlation及one-way ANOVA進行相關檢定分析。
本研究共收集檢傷1至5級個案各80位病人，合計共400位病人。在各項護理處置活動中，以基本護理之平均次數最多，為9.88次，且平均護理工時耗用亦最高，約700.3秒。另外，檢傷級數與各項護理處置活動次數皆呈現顯著負相關(p< 0.001)；即檢傷級數越低 (急迫性越高)，其護理活動次數就越多。再者，檢傷級數與各項護理處置活動工時耗用亦呈現顯著負相關(p< 0.001)；即檢傷級數越低(急迫性越高)，所需護理活動的護理工時耗用就越多。
在19家醫學中心各項護理活動介入程度中，檢驗護理在所有醫學中心的介入程度是相同的，全程皆由護理人員執行；而基本護理、檢查護理及醫療處置護理活動之介入則會依地區不同而有差異 (依序為F=0.19, p=0.17；F= 1.49, p=0.26；F=0.16, p=0.92)。在第一級檢傷至第五級檢傷病人中，每位病人平均所需各項工時耗用的總和分別為57.5分鐘、26.9分鐘、16.2分鐘、8.6分鐘及7.8分鐘，顯示檢傷級數越低 (急迫性越高)，所耗用的工時總和越高；若以第五級檢傷每位病人所需護理活動平均工時耗用為基準，相對第一級至第四級檢傷分級之比例為7.4、3.5、2.1及1.1倍。
本研究結果除能提供各醫院行政單位了解急診各級護理人力配置的需求外，亦可作為未來急診護理人力政策制定之參考，如此才能提升急診護理照護之品質。

關鍵字

護理處置 ； 工時耗用 ； 人力配置

並列摘要

Emergency department is a place to provide emergency medical care for critical patients. However, the nurse staffing level is associated with the quality of patient care outcomes. Therefore, the purposes of this study were (1) to understand and analyze the time spent in nursing management at each level of triage; (2) to compare the differences in nursing activities on all level of triage among nurses in 19 medical centers of Taiwan; (3) to understand and analyze the relative ratio of nursing staffing at all levels of triage.
This study was a descriptive correlational design. Data were collected from an emergency department (ED) of northern Taiwan. A nursing activity check list was used to record the total nursing time spent on the nursing activities, frequency, and direct time spent on ED patients at each level of triage. A structured questionnaire was also administrated to collect the information regarding the involved degree of nursing related management of ED among 19 medical centers in the northern, central, southern, and eastern part of Taiwan. Data were analyzed using SPSS for windows, version 17 (SPSS Inc, Chicago, Illinois). Data were analyzed using the descriptive statistic and inferential statistics including independent sample t, Spearman correlation and one-way ANOVA.
Totally, 400 ED patients, 80 patients on each triage level, were enrolled in this study. The results showed that the foundational nursing activities with a mean frequency of 9.88 times were the most frequently performed activities in nursing. The mean nursing work time spent on foundational nursing was 700.3 seconds. The results also showed that there was a negative relationship between triage levels and nursing activities ( p < 0.001) which indicated that the lower triage level (high urgent), the higher frequency of nursing activities was performed. Similarly, there was a negative relationship between the triage levels and the time spent on nursing activities ( p < 0.001) which indicated that the lower triage level (high urgent), the more time spent on nursing activities.
Nurses involved in laboratory examinations among 19 medical centers were similar; however, there were significant differences in time spent on the fundamental nursing activities, checkups, and medical interventions among medical centers (F=0.19, p=0.17；F= 1.49, p=0.26；F=0.16, p=0.92, respectively). The mean time spent on nursing activities for each patient from triage level 1 to level 5 were 57.5, 26.9, 16.2, 8.6, and 7.8 minutes, respectively. The results indicated that the lower triage level (high urgent), the more time spent on nursing activities. If the time spent on nursing activities on level-5 triage as a reference, the relative ratio in time spent on nursing activities from triage level-1 to level-4 were 7.4, 3.5, 2.1, and 1.1 times, respectively.
The findings of this study may provide the information for hospital administrators to reallocate the ED staffing appropriately and to set up the staffing policy for the future. Thus, the quality of nursing care can be achieved.

並列關鍵字

nursing activities ； time spent ； nurse staffing

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