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  • 學位論文

導入團隊資源管理對急診醫護人員實施高級心臟救命術認知之探討

Investigating the effect of implementing team resource management on emergency medical staffs in regards to advanced cardiovascular life support awareness

指導教授 : 陳芬如

摘要


背景與目的:「急救訓練」是醫療單位的教育訓練重點,尤其急重症單位,更為重要技能的展現;本研究探討第一線緊急救護非外傷到院前心跳停止的病人,對於急診室(Department of Emergency, ED)醫護人員之急救處置認知為研究對象;其目的藉由導入團隊資源管理(TRM)模式的教育訓練及擬真模擬情境演練,探討導入團隊資源管理於急診醫護人員執行高級心臟救命術之認知改變效果。 研究材料與方法:本研究方法經由導入團隊資源管理教育課程,及急救團隊的模擬情境規劃及演練,了解醫護人員對執行「高級心臟救命術」認知之改變資料。本研究為類實驗性研究,以台灣南部某醫學中心急診之醫護人員為收案對象,研究者依據文獻蒐集自行設計問卷,並進行內在信度檢定(Cronbach’s α>0.9),符合信度水準,並進行包含對團隊資源管理(領導、狀況監測、互助、溝通)等模組的資料收集。 研究結果:本研究對象在人口學特性中,女性比例多於男性,年齡層則以26歲〜35歲之醫護人員占多數(38.26%),工作的職業別以護理師佔多數(79.13%),工作年資並無大的差異,但在急診之工作年資中, 3年以下在急診的工作年資佔的比例(60%)最高。在導入團隊資源管理(TRM)後,領導、狀況監測、互助及溝通四個模組認知之差異分析中,p<0.001在統計上呈現有顯著差異,而人口學特性中,在導入團隊資源管理(TRM)之組別分析比較,男女性別的整體評估在互助及溝通模組中,統計上呈現顯著差異,不同年齡層的醫護人員,僅在溝通模組呈現顯著差異,工作職業別、工作年資及急診工作年資的整體評估的認知中,在統計上則呈現無顯著差異。 研究結論 若能積極推廣及落實團隊資源管理之概念,凝聚團隊向心力,促使急診團隊在執行高級心臟救命術時更能完整與準確並能提升其成功率。本研究結論,可提供各醫療臨床實務照顧者及未來研究者,作為實務管理及後續研究之參考。

並列摘要


Background and purpose: Emergency training is the educational and training focus in medical units; it is especially important in intensive care unit (ICU) as it is a way to illustrate important skills. This study investigates the medical staffs in Department of Emergency (ED) on their understandings of advanced cardiovascular life support (ACLS) when treating patients with non-traumatic cardiac arrest. The main purpose was to implement models of team resource management (TRM) in educational trainings and contextual stimulations in order to investigate the intervention of TRM in emergency medical staffs when conducting ACLS. Study materials and methods: The study investigated the improvement of knowledge and ACLS performance after the intervention of TRM education understanding. This is an experimental study based on ED medical staffs in a southern medical center in Taiwan. The survey was designed after gathering data; internal reliability test was done using Cronbach’s α, and the result of >0.9 indicated acceptable reliability. The survey aimed to collect data in four dimensions of TRM including leadership, situation monitoring, cooperation, communication. Result: The sample consisted of more females than males; 38.26% were medical staffs between ages 26-38, 79.13% were nurses. There was no significant difference in seniority; however, 60% of the people surveyed in ED have seniority of less than 3 years. After the intervention of TRM, there was a significant difference of p<0.001 in understanding of leadership, situational monitoring, cooperation, and communication. In terms of demographic, there was a significant difference between males and females in cooperation and communication after the intervention of TRM. Also, there was significant difference in communication amongst different age groups. There was no significant difference in understanding of TRM amongst different occupations, seniority, and ED seniority. Conclusion: If TRM can be actively promoted and conducted, there would be an increase in team cooperation. This would allow emergency team to be more accurate and precise in conducting ACLS, hence increasing the success rate. The findings of this study can be used as a reference in practical management and future studies for medical caregivers in clinical practices and impending researchers.

參考文獻


周致丞(2011)‧跨領域團隊合作照護教育的內容結構與教案規畫概念‧醫療品質雜誌,
張文城(2010)‧運用團隊合作之評鑑模式確保病人安全-以醫療儀器與器材管理為例‧
陳金志、王嘉地、郭雅薇(2010)‧醫療團隊資源管理課程中文化初探‧醫療品質雜誌4(3),85-90。
隊資源管理模式提升病人安全文化‧醫療品質雜誌 42(2),79-81。
黃莉蓉(2009)‧台灣病人安全通報系統藥物事件之分析‧醫療品質雜誌。

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