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  • 學位論文

成人加護病房病人健康照護需求、滿意度及其相關因素探討-以中部某醫學中心為例

Patient's Health Care Demand, Satisfaction and Their Related Factors in Adult Intensive Care Unit: Case of A Medical Center in Middle Taiwan.

指導教授 : 張明正
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摘要


本研究為探索性研究,目的是運用「以病人為中心」的理念,對 成人加護病房病人的健康照護需求與滿意度進行探討。運用結構式問 卷,以中部某醫學中心成人加護病房病人作為研究對象,採取立意選 樣的方法,調查95 年2 月1 日至7 月31 日間住加護病房病人共188 位,所得的資料以描述性統計、相關與邏輯斯迴歸等方法進行分析。 研究結果顯示:成人加護病房病人平均年齡為61.77歲,大部分 的病人已經結婚、有過去病史、住加護病房期間曾經接受侵襲性治 療。整體的健康照護需求屬於中等程度,依序為:生理照護需求屬於 中高程度,情感需求與資訊獲得需求皆屬於中等程度。需求最高的前 三個項目為:「醫護人員執行醫療行為時,能尊重您個人的身體隱 私」、「家人會客時間的探望」與「夜晚時,醫護人員能降低講話的 音量」。整體的健康照護滿意程度屬於中低程度,依序為:情感、生 理照護滿意度屬於中等程度,資訊獲得滿意度屬於中低程度。滿意度 最高的前三個項目為:「家人會客時間的探望」、「朋友會客時間的 探望」及「護理人員適時幫您處理穢物或擦澡,以保持身體潔淨」。 另外,從研究結果中發現:性別、年齡、婚姻狀況、存活子女數、 經濟狀況、有無虔誠的宗教信仰與健康照護需求呈負相關。最高學 歷、病人此次住院是否接受手術、使用呼吸器天數、住加護病房天數 V 與健康照護需求呈正相關。病人人口學特性與健康照護滿意度無顯著 相關。使用呼吸器天數、住加護病房天數及APACHEII分數與健康照護 滿意度呈負相關。整體而言,病人健康照護需求呈現未滿足的狀態, 在控制其他變項後,有非常虔誠宗教信仰的病人健康照護需求高度未 滿足的可能性大於無宗教信仰的病人。有接受手術、住外科系加護病 房的病人、使用呼吸器1~3天、4~7天的病人,健康照護需求高度未滿 足的可能性分別大於沒有接受手術、住內科系加護病房、沒用呼吸器 的病人。 根據研究結果提出以下建議:加護病房空間設計及醫護人員執行 照護活動時,應重視病人隱私。因應病人的個別需求,提供家人與朋 友彈性的探訪時間。燈光的設計,宜採用隱藏式、柔和的燈源,避免 燈管直接照射病人造成不適。夜晚時,減少燈光照明並停止院內及加 護病房內廣播系統、使用低噪音的工作車和急救車、醫護人員交班及 討論事情時應降低講話的音量,以提供病人安靜、舒適的休養環境。

並列摘要


This is an explorative research on adults in intensive care units, focusing in particular to the patients’ health care demands and their satisfaction levels. The research was carried out in the middle Taiwan Medical Centre’s intensive care unit from 1 February 2006 to 31 July 2006. Purposive sampling was used to select research subjects. A total of 188 patients were interviewed. The data collected was then analysed. The average age of the patients were 61.77 years old. Most of the patients were married, had past medical history, and had received some form of invasive treatments. These patients had mid to high levels of physical demands, and mid levels of emotional demands. The three most highly rated concerns by these patients were: 1) respect patients’ privacy, 2) allowed visiting hours of family and friends by hospital, and 3) noise levels in the intensive care units. Satisfaction levels of these patients in intensive care units are mid to low levels. These patients reported mid levels of satisfaction regarding their psychological and physical needs, and reported mid to low levels of satisfaction with regards to medical information received from ICU staff. The areas reported to be of most satisfaction including family and friends visiting hours, and nurses’ care towards patients’ hygiene. Gender, age, marital status, number of living children, economic status and commitment to religion, are some factors found to be negatively related to patients’ health care demands. Educational level, whether the patient had underwent surgery, the duration of a patient on the ventilator support and the duration of stay in the intensive care units, are some of the factors positively related to patients’ health care demands. Patients’ demographics have been found to not affect their satisfaction levels. However, the duration of being on a ventilator, duration of stay in the intensive care unit, and the APACHEII score are negatively related to patients’ satisfaction levels. In general, patients who are committed to a religion have less health care demands and are found to be less satisfied, even after other variables have been controlled. This satisfaction level is lower than those who were not committed to a religion. It was also found that patients in the surgical intensive care units who have used ventilators, have higher health care VII demands and are found to be more satisfied than patients in the medical intensive care units who had not underwent surgery and did not require use of ventilators. Some recommendations following the research, include improving the design of the intensive care units, provide more privacy to patients, more flexibility to visiting hours, reduce in noise levels, and reduction of harsh lighting in the intensive care units. All these recommendations are to provide a more conducive environment for patients’ recovery.

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