醫護人員對病人安全文化態度及行為之研究—以急診部門及麻醉部門為例

A Study of Medical Staff’s Attitudes and Behaviors toward Patient Safety Culture –Case studies from the Emergency and Anesthesia

王佳敏(Chia-min Wang)

指導教授 ： 黃建財

中臺科技大學/管理學院/醫護管理研究所/碩士(2008年)

https://doi.org/10.6822/CTUST.2008.00005

摘要

病人安全已是世界各國醫界所重視的議題，而薄弱的安全文化是導致不良事件的因素之一，醫師與護理人員在醫療團隊中位居第一線，如有不慎，即可能造成醫療疏失，故本研究針對醫護人員的病人安全文化態度及行為做一探討。
本研究採用李氏安全文化量表及施氏病人安全行為量表經專家修改後，進行病人安全文化態度與行為的測量，本研究針對16家醫療機構的麻醉及急診部門之醫護人員為研究對象，總共發放450份問卷，回收417份有效問卷，有效回收率約為92.6%。
本研究醫護人員年齡平均為32.0±7.7歲，結果顯示醫護人員對於病人安全文化態度的平均分數介於3.1~3.9分，病人安全行為表現平均分數介於3.1~4.1分。受訪者使用通報系統的比率未達50%，且人力負荷之問題近七成受訪者表示人力不足以應付工作量。經過t檢定與單因子變異數分析，發現醫護人員個人屬性不同，包括年齡、婚姻、職稱、臨床別、醫院性質，對於病人安全文化態度及病人安全行為表現呈顯著差異(p < .05)，進一步發現，年齡較大( 41歲以上)對病人安全文化態度及病人安全行為表現較佳；已婚之醫護人員對病人安全文化態度較佳；醫學中心的受訪者壓力較大，另外亦發現急診醫護人員的工作壓力較大。以複迴歸分析醫護人員病人安全文化態度對病人安全行為表現的影響，發現「團隊氣候」、「安全氣候」與「病人安全行為表現」呈現正相關，「壓力認知」與「病人安全行為表現」呈現負相關(p < .05)。
病人安全的目標不只是在於報告醫療錯誤，而是在第一時間去預防醫療錯誤。整體而言，醫護人員年齡較輕、未婚，對病人安全文化態度及病人安全行為表現較薄弱；醫學中心的受訪者及急診醫護人員壓力較大。故建議應培養學習的文化，亦將病人安全文化納入教育課程裡，讓醫護人員體認病人安全照護的重要性；並應重視醫護人員之壓力問題，提供適當的機會及相關途徑與技巧，來減低壓力。

關鍵字

病人安全文化 ； 安全態度量表 ； 急診 ； 麻醉

並列摘要

Patient safety is already an international health issue now, and weak safety culture is one of the factors that lead to an adverse event. Physicians and nurses are at the forefront of medical team, and if they are somehow careless, a medical error can occur. The purpose of this study is to research the medical personnel’s attitudes and behaviors about patient safety culture.

This study adopted the questionnaire that was adapted from Lee safety culture questionnaire and Shih patient safety behavior questionnaire, and focused on the anaesthesia and emergency department medical personnel in 16 medical organizations. Surveys were completed by 417 of 450 respondents; the effective return rate achieved 92.6%.

In this study, the medical personnel’s mean age was 32.0±7.7. The mean score of medical personnel’s attitudes about patient safety culture was 3.1 to 3.9, and the one about the performance on patient safety behaviors was 3.1 to 3.4. The survey data showed that the respondents who use the reporting system are less than 50%, and nearly 70% respondents express that the manpower is insufficient to handle the heavy workload. Through the analyses of t-test and ANOVA, the results showed that medical personnel with diverse age, marriage condition, job title, clinical type, and hospital property have significant differences in attitudes of patient safety culture and performance on patient safety behaviors (p < .05). Furthermore, we found that older medical personnel (41 years old and above) have better attitudes of patient safety culture and better performance on patient safety behaviors; married medical personnel have better attitudes of patient safety culture; medical personnel working in medical centers have higher stress; besides, we also found emergency medical personnel have higher stress. To utilize multiple regression analysis to analyze the influence of medical personnel’s attitudes of patient safety culture on the performance on patient safety behaviors, the researcher revealed that “ performance on patient safety behaviors” has positive correlations with “teamwork climate” and “safety climate,” and negative correlation with “stress recognition” (p < .05).

The goal of patient safety is not only to report medical errors, but to prevent medical errors at the first moment. According to the results of this study, younger and single medical personnel have weaker attitudes of patient safety culture and also weaker performance on patient safety behaviors; medical personnel working in medical centers and emergency medical personnel have higher stress. The researcher suggest that the learning culture should be developed, and the patient safety culture should be combined into the education curriculum to let the medical personnel realize the importance of patient safety care; meanwhile, improvements of stress of medical personnel should be carried out to offer ways and skills to reduce stress.

Keywords：anaesthesia, emergency, safety attitude questionnaire, patient safety culture

並列關鍵字

patient safety culture. ； safety attitude questionnaire ； emergency ； anaesthesia

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