以台北縣市四所醫院營養諮詢門診實況為例的一項質性研究

A Qualitative Study for Nutrition Counseling of four Hospitals in Taipei City and County

盧立卿(Li-Ching Lyu) ； 余雅萍(Ya-Ping Yu) ； 李蕙蓉(Huei-Rong Lee)

《臺灣營養學會雜誌》 32卷4期 (2007/12) Pp. 108-118

https://doi.org/10.6691/NSJ.200712_32(4).0001

摘要

本研究為探討營養諮詢需求評估系列研究（民國88-89年）之旁觀式觀察結果。為了解營養諮詢之方式與探討提升服務品質之道，研究收集整理台北縣市包括台北市13家公立及15家私立醫院，台北縣6家公立及9家私立醫院營養諮詢門診實況，並觀察大台北地區兩所公立醫院及兩所私立醫院營養諮詢門診的環境實況及操作情形，全程記錄病患與營養師所有對話及該診活動，並以逐字稿分析營養師及病患的諮詢內容及互動情形。研究結果分營養師、病患及環境因素三面向。分析發現營養師在諮詢準備及內容有專業的一致性及具相當的權威感及能力，但諮詢方式需改善溝通模式，應更以病人為中心。也發現求診病患面對疾病的態度會強烈影響尋求飲食指導的動機，所以應多陪伴傾聽以增進互信及提高其動機。醫院中營養諮詢門診為重要之衛教服務，但是諮詢內容的標準化、給付或收費標準、及病歷流通的流程是需要努力的方向；其發展與整體醫療體系發展是相輔相成的。健保給付制度、醫院管理政策、整體醫療環境、民眾的認知、及收費的方式與額度都會影響到營養諮詢門診的運作及成效。

關鍵字

營養諮詢門診 ； 旁觀式觀察法 ； 營養師

並列摘要

This study documents unobtrusive observations of a nutritional counseling research series conducted n 1999 and 2000. To understand the[means/methods?] and contents of nutrition counseling and improve toe quality of this service, we collected operational information from all hospitals hiring dietitians in Taipei (13 public and l5 private hospitals) and County (6 public and 9 private hospitals Moreover, we observed and documented all activities during 4 counseling sessions in 2 public and 2 private hospitals in Taipei City and Counts. All conversations and activities were tape-recorded and analyzed for 3 major facets of dietitians, patients, and environmental aspects We found that toe contents of the dietary counseling were professional and consistent for dietitians equipped with [profound/adequate?] knowledge. However consultation and communication skills need to be more client-centered, which can help improve the efficacy. Patients΄ attitudes toward their illnesses affect their motivations for c hanging dietary behaviors. Since nutritional counseling is an important heath educational service we need to develop standardized counseling procedures, reimbursement or payment systems, arid a moo cal chart recording system in the future. Nutritional counseling shores a similar reality with the rest of foe med cal system, i.e, the success of the operation of nutrition counseling clinics is highly determined by the medical systems including health, insurance reimbursement, hospital management, social recognition and fee-charging systems. Therefore, we need to examine and improve the quality of nutritiona1 counseling clinics in order to provide better services to help par cots in need.

並列關鍵字

nutrition counseling ； unobtrusive observation ； dietitian