運用共聘照護模式於護理人員工作負荷、感受及滿意度之探討

背景:台灣老年人口依賴比率、國家老化指數逐年增加，疾病型態逐漸以慢性疾病和生活型態相關疾病為主，而社會、家庭結構改變及護理人力短缺，住院病人基本照護工作即轉嫁到家屬身上。2017年國內試辦推廣住院病人友善照護醫院模式，運用「共享經濟(Sharing economy)」概念，由住院病人共同聘僱照顧服務員，促進照顧人力有效率運用，緩解護理人力短缺困境。目的: 比較共聘照護模式與傳統照護模式的護理人員其工作負荷、工作感受及滿意度的影響是否有差異。方法:本研究為橫斷式研究設計，以結構式問卷調查方式進行資料收集。研究場所為中部地區的教學醫院護理部所屬內科病房，針對有推動共聘照護模式之病房為「共聘照護組」及無推動共聘照護模式之病房為「傳統照護組」為研究對象，分別收案53位及47位護理人員，共100位。回收完整問卷分別為51位 vs.45位，回收率96%。以SPSS 22.0 統計套裝軟體進行資料分析，統計方法包括次數、百分比、平均值、標準差、卡方檢定、獨立樣本 t 檢定。結果:研究結果顯示兩組護理人員之基本屬性資料同質性高，均無顯著差異(p>.05)。兩組工作感受上；共聘照護模式平均3.78±0.5、傳統照護模式平均3.43±0.3，呈顯著差異(p=0.002)。其中在與照服員合作關係及工作輔助，提升護理專業照護、照護品質等細項，均達顯著差異(p<.05)。護理工作負荷程度量表於共聘照護組平均分為3.52±0.8、傳統照護組平均分為3.44±0.4，無顯著差異(p=.58)。護理工作滿意度量表於共聘照護組平均分數為3.37±0.4、傳統照護組平均分數為3.22±0.4，無顯著差異(p=.10)，但在專業的參與裡的細項「我有專業上拓展的機會」，共聘照護組3.27±0.6、傳統照護組2.98±0.5，呈顯著差異(p=.22)。結論: 研究結果初步顯示共聘照護模式可提升護理人員較正向的工作感受，但工作負荷及滿意度則無顯著差異。護理人員是重要的照護團隊之一，當各醫院努力改革照護環境，採多元策略進行護理人力的留任和回流，本研究結果可初步提供應用此模式之參考。共聘照護模式是否推廣，建議未來有更多研究以瞭解共聘照護模式的成效。

關鍵字

共聘照護模式；護理工作負荷；工作感受；護理工作滿意度

並列摘要

Background: Chronic and lifestyle-related diseases are the most common diseases in Taiwan. Due to the shortage of nursing staff, basic nursing work for patients has been transferred to family members. In 2017, the hospital-friendly shared care model was promoted with the concept of “sharing economy”, and the shared care model was promoted for inpatients to alleviate the nursing shortage. Aims: To explore differences in workload, work perception, and job satisfaction among nursing staff between the shared attendant care model and the traditional care model. Methods: Data for this cross-sectional study was collected using a structured questionnaire. This study was conducted on the nursing department internal medicine wards at teaching hospitals in the central region. Wards that promoted the shared attendant care model were the “shared attendant care group”, and wards that did not promote the shared attendant care model were the “traditional care group”. There were 51 and 45 completed questionnaires for nursing staff, respectively, for a response rate of 96%. The data were analyzed using the chi-square test and independent sample t-test, and presented as the number, percentage, mean, and standard deviation. SPSS v.22.0 was used for data analysis. Results: The demographic data for both groups showed high homogeneity and no significant differences between the groups (p>.05). For work perception between the two groups, the average of the shared attendant care group was 3.78±0.5, and the average of the traditional care group was 3.43±0.3, which was significantly different (p=.002). There were significant differences (p<.05) in the cooperation relationship with the attendant, assistance at work, improvement of professional nursing care, and nursing quality. The average nursing workload score was 3.52±0.8 in the shared attendant care group and 3.44±0.4 in the traditional care group, which was not significantly different (p=.58). The average nursing job satisfaction score was 3.37±0.4 in the shared attendant care group and 3.22±0.4 in the traditional care group, which were not significantly different (p =.10). However, for “opportunity for further development”, the shared attendant care group score was 3.27±0.6, and the traditional care group score was 2.98±0.5, which was significantly different (p=.22). Conclusions: This study showed preliminary results indicating that the shared attendant care model can improve nurses’ positive work perception, but there was no significant difference in workload and satisfaction. This model can provide hospitals with information during reform of the healthcare environment and when adopting multiple strategies for the retention and return of nursing staff. However, further research on the shared attendant care model is required to understand its effectiveness.