以公共衛生護理人員觀點分析探討嘉義縣『醫療到家 健康幸福』執行現況

Analysis and Evaluation of "Medical Care Sent Home for Health and Wellbeing"in Chiayi County via the Perspective of Public Health Nurses

廖念慈(Liao Nian-cih)

指導教授 ： 謝嫣娉

亞洲大學/健康學院/長期照護研究所/碩士(2008年)

摘要

面臨台灣地區人口老化、慢性疾病增加的趨勢，如何減緩醫療資源重複性耗用與提升老年人健康生活照護品質，是當局施政重點。本研究針對嘉義縣『醫療到家 健康幸福』執行現況做分析探討，因其為創新行動服務，以衛生所護理人員為行動的主要執行者，以老人與慢性病患的醫療後續照護為主要工作內容，因此本研究採質性研究方法，以執行服務的公共衛生護理人員做為深度訪談的對象，採半結構式進行調查、分析。
本研究以『醫療到家 健康幸福』相關計畫文獻進行本活動與⑴出院準備服務之關係、⑵服務理念與流程之討論、⑶公共衛生護士角色與功能、⑷服務品質與前景等四大重點進行深度訪談。經分析探討整理結論如下：
一、針對『醫療到家 健康幸福』活動特色：
(一) 可直接從醫療院所取得個案特定疾病名單或住院資料，不必為了重建資料再次篩檢，反被動為主動。
(二) 重視出院老人之醫療關懷與慢性病防治工作，提高這兩類民眾痊癒機率，進而有效減少醫療資源耗用。
(三) 能主動發現無照護系統之個案，建立適當照護系統。
(四) 活動理念深受基層執行者(公衛護士)的認同。
(五) 強化地方政府積極執行福利政策照顧民眾的形象。
(六) 公共衛生護士在本活動之角色功能為：⑴個案問題發現者、⑵提供健康照護者、⑶衛生教育宣導者、⑷健康保健諮詢者。
二、針對『醫療到家 健康幸福』另外建議如下：
(一) 應改善醫療院所通報的時效性與資料正確性，使公衛護理人員快速掌握個案正確的需求。
(二) 應確實要求出院紀錄的完整性，避免陷入以單一疾病為思考方向的窠臼。
(三) 須解決因再度入院而衍生之不容易結案、個管時間過長、重複使用相同照護資源等問題。
(四) 須再加強公衛護理人員個案評估、時間管理、慢性病照護等能力之在職教育，有效提升公衛護理人員專業素養。
(五) 應增加其他醫療專業成員參與，如社工師、營養師、心理治療師、藥師等，才能建立完整照護系統。

關鍵字

『醫療到家 健康幸福』 ； 公共衛生護理人員 ； 慢性病防治

並列摘要

Due to the facts of the increased aged population and chronic diseases, the government has focused on how to reduce the repeated uses of medical resource and how to enhance the quality of health care for the elders. Therefore, this study is to analyze and evaluate the “Medical Care Sent Home for Health and Wellbeing”which is carried out in Chiayi County for more than one year. Because “Medical Care Sent Home for Health and Wellbeing”is an innovative service, and the nurses in the public health clinics are the main care takers, and the content of the service is mainly for the follow-up treatments for the elders and chronic patients, therefore,the method for the study is to interview the enforcers of the project, namely, the public health nurses in a thorough manner, and to employ a semi-structural survey and analysis.
The researcher conducted a thorough interview from the project plan to 1. find out the relationship between the service activities and the preparation to leave the hospital, 2. conduct a discussion of the relationship between service ideas and service procedures, 3. evaluate the role and functions of a public health nurse, 4. analysis the quality of the service activities and vision of the project,in order to how well the project is carried out. Furthermore, this study is to analyze the problem faced by the public nurses when they administer the project, and put their views inductively into systematic codes so as to reach a valuable conclusion:
1. The characteristics of “Medical Care Sent Home for Health and Wellbeing”:
(1) The public health nurses can get the lists of specific cases and the data of the hospitalized, and they don’t need to screen the patients in order to reestablish the data.
(2) Focus on the elders who are not hospitalized and the preventive measures for the chronic diseases in order to raise the healing probability of these two groups so as to reduce the waste of medical resource.
(3) Be able to find out the cases under no medical care services so as to assist the disadvantageous groups and build a appropriate care taking system.
(4) The project ideals are accepted with enthusiasm by the front line enforcer, namely public health nurses.
(5) The performance of the project was deeply agreed upon and supported by the citizens of the county, and the image of the local government striving to execute its social welfare policies and taking good care of its citizens is strengthened.
(6) The role and functions of public health nurses in the project: 1.Turn passiveness to positiveness, and become a finder of a problematic case. 2.Directly understand the needs of a particular case, and become a supplier of the health care.3.Become a public health educator via this activity.4.Become a health consulter via the acquaintance of the local people through the activity.
2. There are certain suggestions of “Medical Care Sent Home for Health and Wellbeing”as follows:
(1) The accuracy of the data sent by the hospitals or the clinics should
be improved in order to speed the handling the needs for the cases.

(2) The completeness of the medical history of the patients should be
required in order to avoid the mistaken single illness
consideration.

(3) The difficult cases due to prolonged treatment and repeated
medical care in the re-hospitalization should be resolved.

(4) The continuous education for the nurses’capability to evaluate a
case, manage time and take care a chronic patient should be
enhances so as to upgrade the professionalism of public health
nurses.

(5) Include the other specialists to take part in the project such as
social workers, nutritionists, psychiatrists, pharmacists in order to
build a comprehensive medical care system.

並列關鍵字

『Medical Care Sent Home for Health and Wellbeing』 ； Public Health Nurses ； Chronic Deceases

參考文獻

行政院衛生署國民健康局（2006）。2005年臺灣各縣市衛生所統計年報。台北縣，行政院衛生署國民健康局。

行政院衛生署國民健康局（2006）。2005年臺灣各縣市衛生所統計年報。台北縣：行政院衛生署國民健康局。

吳淑瓊、江東亮﹙1995﹚。台灣地區長期照護的問題與對策。中華衛誌，14(3)，246-254。

陳晶瑩（2003）。老年人之長照護。臺灣醫學，7(3)，404-413。

蔡宗學、莊坤洋、戴玉慈、曾淑芬、吳淑瓊(2004)。中風病人具身體功能障礙者出院準備服務之執行評估：病人的角度。台灣衛生雜誌，23(3)，235-248