影響呼吸器依賴病患家屬選擇呼吸照護病房因素及滿意度調查

Factors Affecting the Selection and Satisfaction of Respiratory Care Ward for Families of Ventilator-Dependent Patients

高秀娥(Hsiu-O Kao)

指導教授 ： 李碧霞

臺北醫學大學/護理學院/護理研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00057

摘要

本研究旨在探討影響呼吸器依賴病患家屬選擇呼吸照護病房因素及滿意度調查。以臺北縣市41所呼吸照護病房之主要決策家屬為研究母群體，隨機抽出20所呼吸照護病房，以結構式問卷進行調查，共發出320份問卷，回收有效問卷288份，回收率94.4 %。所得資料以Mann-Whitney test、Kruskal-Wallis test、Spearman's correlation、MANOVA 檢定進行推論性統計分析。
研究結果發現：
ㄧ、「專業服務」、「價格因素」及「方便性」構面為呼吸器依賴病患家屬選擇呼吸照護病房的重要考慮構面。較重視的選擇機構因素前五項依序為：醫德、護理人員服務態度、醫術、醫師服務態度與護理人員的技術。
二、呼吸器依賴病患家屬選擇呼吸照護病房的訊息來源中，以來自原轉出醫院提供照護機構簡介單張或手冊最多，選擇機構時的訊息足夠度明顯不足。
三、呼吸器依賴病患年齡愈大、意識狀態較好及決策家屬為病患女兒者較重視「專業服務」構面；未婚的決策家屬較重視「硬體規劃」與「作業服務」構面；有宗教信仰及信仰道教的決策家屬較重視「方便性」構面；決策家屬教育程度為大專以上及訊息來源不足夠者較重視「硬體規劃」、「作業服務」與「專業服務」構面。
四、決策家屬對病患接受呼吸照護病房醫療服務後整體滿意度平均得分為3.98分（介於滿意與普通之間），滿意度總量表平均得分為3.88分（滿分5 分）。決策家屬較滿意「專業服務」、「作業服務」與「價格因素」構面，而滿意度得分最高前五項依序為：訪客彈性、護理人員服務態度、呼吸治療師服務態度、呼吸治療師技術、護理人員技術。
五、男性及步行組的決策家屬較滿意「方便性」構面，有職業的決策家屬較滿意「專業服務」構面，而訊息來源足夠的決策家屬較滿意「硬體規劃」、「作業服務」、「專業服務」、「價格因素」與「方便性」五項構面。
本研究建議急重症單位應強化出院準備團隊功能；呼吸照護病房管理者應定期掌握家屬的最新需求，並依家屬較重視而不滿意的機構因素著手改善；而政府部門應建置照護機構資源網，以增進醫療服務市場之效率。

關鍵字

選擇機構因素 ； 滿意度 ； 決策家屬 ； 呼吸器依賴病患

並列摘要

The purpose of this study was to determine the factors affecting the selection and satisfaction of Respiratory Care Wards (RCWs) for families of ventilator-dependent patients. Questionnaires were developed to survey the main decision-making family members of ventilator-dependent patients from 20 randomly selected RCWs among 41 RCWs in Taipei. A total of 320 questionnaires were sent out and 288 (94.4%) of valid questionnaires returned. The statistical analyses were performed by Mann-Whitney test, Kruskal-Wallis test, Spearman's correlation coefficient and MANOVA.
The main findings were shown as follows:
1. Professional service, price factor and convenience were the main factors affecting the family decision for ventilator-dependent patients in the selection the RCW. The results revealed that the physician’s moral values, the nurse's service attitude, the physician’s skills, the physician’s service attitude, and the nurse's skills were concerned the most by decision-making families of ventilator-dependent patients'.
2. The information source for the decision-making families of ventilator-dependent patients to choose among the RCW is mainly from the broche from RCW, and this obviously can not provide adequate information for these families.
3. If the patient's age is older, the patient’s consciousness state is better or the decision maker is patient’s daughter, then the decision-making relatives paid more attention to the professional service of RCW. Unmarried decision-making relatives paid more attention to hardware plan and the general service. The decision relatives who had religious belief or believe in Taoism paid more attention to the convenience. If the he relatives had higher education degree, or the relatives had not enough information, then the decision-making relatives pay more attention to hardware plan, regular service and the professional service.
4. The satisfaction of the decision-making relatives on the RCW medical care is between “satisfied” and “ ordinary”, with a score of 3.98. The average score of satisfaction evaluation scale is 3.88. The decision-making relatives were most satisfied in the aspects of professional & regular service and the service fee. The top five items of satisfaction were: flexibility in visiting hours, nursing staff's attitude, respiratory therapist's attitude, respiratory therapist's skills, and the nursing staff's skills.
5. Among the relatives, males and “walking” group were more satisfied in the “convenience”. The decision-making relatives who have formal job were more satisfied in the “professional service”, while those who have sufficient information were more satisfied in the “hardware plan”, “regular service”, “professional service”, “service fee” and “convenience”.
This research suggests that the critical care unit should strengthen the team-work function, while the RCW manager should regularly check the families’ latest demands, as well as address the important and unsatisfied aspects by the families. We also propose that the relevant government departments should establish the RCW organization's resource network, in order to improving the effectiveness of medical care systems.

並列關鍵字

the hospital choice factors ； satisfaction ； decision families ； ventilator-dependent patient

參考文獻

張苙雲（1998）•「逛醫師」的邏輯：求醫歷程的分析•臺灣社會學刊，21，59-87。

楊琇茹（2004）•從病患自主權看病患家屬參與醫療決定之權限•未發表碩士論文，中原大學，桃園。

高美英、呂碧鴻（2000）•慢性病患者對醫療院所之滿意度評量•臺灣家庭醫學雜誌，10（4），212-224。

龍芳、林恆慶（2005）•管理式醫療與呼吸器依賴患者整合性照護計畫•中華民國呼吸照護簡訊，16（1），63-70。

蘇千玲、楊式興、吳清平（2005）•臺灣呼吸照護整合系統現況與未來• 呼吸治療， 16（1），57-62。