醫院護理人員對新制醫院評鑑之認知探討

A Study of Nursing Staff Perceptions of Reformed Hospital Accreditation in Taiwan

劉欣眉(LIU HSIN MEI)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

新制醫院評鑑是從病人權益、醫學教學、醫療品質、病人安全等角度上，以外部評核方式督促醫院並謀求改進，促使醫院之醫療照護達到最完善為目的。護理作業為醫院評鑑重要的一環，因護理人員是病人照護的核心，當護理人員經由評鑑過程確能提昇護理服務品質時，會為病患健康帶來正面的價值與貢獻。近年發生多起重大病安事件及醫院受到SARS衝擊，醫界深感有必要大幅改革評鑑制度與評量基準，故衛生署委託醫策會組織專家小組，制訂新制醫院評鑑，於2005年下半年度正式實施。護理主管是位居建立制度、流程及架構之重要角色，而護理員則是執行實務面及與病人互動的的第一線服務人員，故本研究目的係為瞭解並比較醫院護理主管與護理員，對新制醫院評鑑護理組評鑑基準內容及作業面的認知及認知差異，與醫策會所建議內容之差異。本研究為描述性橫斷性研究設計，分別在北部、中部、南部立意取樣出有參加新制醫院評鑑的區域及地區醫院各3家，共9家醫院進行研究，研究對象為護理主管與護理員，並以結構性問卷進行本研究。經問卷調查結果如下：
（1）新制醫院評鑑護理組評鑑基準內容之認知及其差異：重要性的前5名與相關性是一致的，其中「給藥之正確性」與「病房藥品與管制藥品管理健全」（重要性的前2名）在準備上是容易的。另外，不論在護理主管或護理員，其所認為重要的6至10名之題目與相關性大多是一致的；而在準備難易度上的認知差異，似乎與重要性、相關性沒有絕對的關係。護理主管與護理員造成認知差異的原因多源自於工作範疇的不同，熟悉的工作業務不同，導致護理主管偏重行政方面，而護理員偏重在臨床實務上。
（2）新制醫院評鑑護理組評鑑作業面的部分：在評鑑時間的適當性部分，在250床以上醫院的評鑑時間較具爭議性。護理人員非常認同與需要講評，且認為夜間評鑑重要，可達評鑑目的，也認同評鑑過程中進行訪談。但在護理評鑑委員彼此間在評鑑上的一致性部分，認為不一致的人較多，並超過1/4的比例；在護理組所評核的155項佔所有評鑑項目的比例方面，護理主管希望評鑑項目的比例可再降低。在進行評鑑通知的時間點部分，認為目前14天前進行通知不適當的人較多，並且其建議通知評鑑時間提前為平均24.79±17.76天前。
新制醫院評鑑護理組評鑑基準內容於護理人員的認知上有些許差異，所以，評鑑委員、醫院與護理主管、護理員需要再進一步進行協商、溝通及教育。也期盼此研究之結果與討論，能提供醫策會與護理部門參考，為下次評鑑時修訂評鑑指標/準備評鑑之依據。

關鍵字

護理人員 ； 新制醫院評鑑

並列摘要

The Reformed Hospital Accreditation scheme (RHA), by way of external assessment, aims to urge hospitals to seek improvements in aspects such as patient rights, medical instruction, quality of treatment and patient safety, thus allowing the best possible treatment and care to be offered. Nursing operations are an important element in hospital accreditation, because nursing staff are at the core of patient care. When the quality of nursing care can be raised via the process of accreditation, this is undoubtedly of benefit to patient health. In recent years, following a number of major patient safety incidents in hospitals as well as the SARS crisis, the medical community has strongly felt the need for substantial reform of the accreditation system and its assessment criteria. Consequently, the Department of Health entrusted a team of experts from the Taiwan Joint Commission on Hospital Accreditation (TJCHA) to draw up a new accreditation system, which was formally brought into effect in the latter half of 2005. Nurse managers play an important role in setting up the systems, procedures and frameworks of nursing care in hospitals, whereas assistant nurses, as the frontline workers interacting with patients, are responsible for its practical implementation. Therefore, the objective of this study is to understand and compare the perceptions nurse managers and assistant nurses have of the assessment criteria and operation of the RHA Nursing Section, along with any discrepancies that may exist with the content suggested by the TJCHA. The study takes the form of a descriptive cross-sectional analysis, with samples taken from three regional/district hospitals participating in the RHA scheme from each of the northern, central and southern regions, a total of nine hospitals; the objects of the study were nurse managers and assistant nurses, and research was carried out by structured questionnaire.

The findings of the questionnaire were as follows:
(1) Perceptions of the accreditation criteria used by the RHA Nursing Section: the five criteria judged most important correlated exactly with the five placed top for relevance, of which “accuracy of drug delivery” and “sound administration of ward drugs and controlled drugs” (the two placed top for importance) were also judged to be easy in terms of preparation. In addition, the criteria placed sixth to tenth in terms of importance by both nurse managers and assistant nurses were largely consistent with those placed sixth to tenth for relevance. However, there appears to be no correspondence between perception of preparation difficulty, importance and relevance. Discrepancies in perception between nurse managers and assistant nurses largely arise from differences in work scope and level of familiarity with work tasks, which resulted in nursing managers placing greater emphasis on administrative aspects, and assistant nurses stressing clinical practice.

(2) The operation of the RHA Nursing Section: when it came to the appropriateness of the accreditation period, the accreditation period for hospitals with more than 250 beds was relatively controversial. Nursing staff strongly support and need evaluation, believe night time accreditation to be important, and support interviews during the accreditation period. However, regarding the consistency of assessment of carried out by accreditation officers, over one quarter of those surveyed believed this to be inconsistent. With regard to the proportion of total hospital accreditation criteria that the 155 items assessed by the Nursing Section make up, nurse managers hoped that this proportion can be reduced. With respect to the period of notification given prior to commencement of accreditation, many felt the present period of 14 days notice to be insufficient, on average suggesting that 24.79±17.76 days notice be given.

Some discrepancies exist between the assessment criteria laid out by the RHA Nursing Section, and nursing staff perceptions of such. Therefore, more consultation, communication and education should take place between accreditation officers, hospitals, nurse managers, and assistant nurses. It is hoped that the results and discussions presented in this study will be of useful reference to the TJCHA and nursing departments, and serve as a basis from which assessment standards can be amended and the next round of accreditation prepared for.

並列關鍵字

Nursing staff ； Reformed Hospital Accreditation

參考文獻

財團法人醫院評鑑暨醫療品質策進會e（2004，1月）‧澳洲評鑑制度考察‧公務出國報告書。

蘇喜（1996）‧醫院評鑑評量表指標及配分適切性研究‧中華衛誌，15（3），　　　　　　　228－248。

Wang, J-W., Yeh, T-F., ＆Tseng, K-Y.（2003）.The meta-analysis for the trend of hospital accreditation in Taiwan. Chung Shan Med J, 14, 513-522.

尹裕君（2005）‧新制醫院評鑑與護理品質管理‧榮總護理，22（2），109-116。

李玉華（2002）‧醫院評鑑對護理品質之影響‧高雄醫學大學健康科學院公　　　共衛生研究所碩士論文。